From the Guidelines
Microalbuminuria is not a known side effect of liraglutide, and in fact, liraglutide may have renal protective effects in some patients with diabetes. Liraglutide (brand names Victoza, Saxenda) is a GLP-1 receptor agonist used for type 2 diabetes and weight management. Common side effects include nausea, vomiting, diarrhea, constipation, decreased appetite, and injection site reactions. More serious but less common side effects may include pancreatitis, gallbladder disease, hypoglycemia (especially when used with insulin or sulfonylureas), and potential thyroid C-cell tumors.
Key Points
- Liraglutide has been associated with a reduction in the risk of new-onset persistent macroalbuminuria, as seen in the LEADER trial 1.
- The use of GLP-1 receptor agonists, including liraglutide, has been shown to reduce albuminuria and slow eGFR decline, as evidenced by secondary outcomes assessed in cardiovascular outcomes trials and a clinical trial for glycemic efficacy and safety in patients with T2D and eGFR 15–59 ml/min/1.73 m2 1.
- The most common side effects of GLP-1 receptor agonists, including liraglutide, are nausea, vomiting, and diarrhea, which occur in 15%–20% of patients with moderate-to-severe CKD (CKD stages G3 and G4) but usually are tolerable with dose titration and abate over several weeks to months 1.
Renal Protective Effects
The renal protective effects of liraglutide are thought to be due to its ability to improve glycemic control, reduce blood pressure, and promote weight loss.
- A meta-analysis of 8 cardiovascular outcomes trials found that GLP-1 receptor agonists, including liraglutide, significantly reduced the risk for a composite kidney disease outcome (macroalbuminuria, eGFR decline, progression to kidney failure, or death from kidney disease) compared with placebo, largely driven by reduction in albuminuria 1.
- In a glycemic efficacy and safety trial in patients with moderate-to-severe CKD (CKD stages G3 and G4), dulaglutide was compared with insulin glargine as basal therapy, and dulaglutide produced similar glycemic control but resulted in significantly slower GFR decline 1. If you're experiencing microalbuminuria while taking liraglutide, it's more likely related to underlying diabetes or other conditions rather than the medication itself.
From the Research
Liraglutide Side Effects
- The study 2 evaluated the safety of liraglutide treatment in patients with chronic kidney disease (CKD) and found that serious adverse events were more frequently recorded in patients with CKD compared to those without CKD.
- However, the study 2 found no interaction of adverse events with randomized therapy in patients with micro- or macroalbuminuria.
- Microalbuminuria is defined as a persistent elevation of albumin in the urine of >30 to <300 mg/d 3.
- The study 2 included 2456 patients with microalbuminuria and found that liraglutide reduced the risk of severe hypoglycemia in patients with CKD or with micro- or macroalbuminuria.
Relationship Between Liraglutide and Microalbuminuria
- The study 2 did not find any significant difference in adverse events, including microalbuminuria, between patients treated with liraglutide and those treated with placebo.
- However, the study 3 suggests that microalbuminuria is a marker of endothelial dysfunction and a predictor of increased cardiovascular risk.
- The studies 4, 5, and 6 evaluated the effects of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) on kidney outcomes, including microalbuminuria, but did not investigate the relationship between liraglutide and microalbuminuria.
Conclusion on Liraglutide and Microalbuminuria
- Based on the available evidence, it appears that microalbuminuria is not a direct side effect of liraglutide treatment.
- However, patients with CKD, including those with microalbuminuria, may experience serious adverse events, including severe hypoglycemia, when treated with liraglutide 2.