New insights in incretin treatment in diabetic and non-diabetic kidney disease

Chronic kidney disease is becoming more prevalent, partly due to the increase obesity and consequently type 2 diabetes. These conditions elevate the risk of both kidney and cardiovascular diseases. Treatment focuses on improving blood sugar, blood pressure, weight, and protein loss in urine, with medications like RAAS inhibitors and SGLT2 inhibitors playing a key role. However, despite these treatments, many patients still experience worsening kidney function, highlighting the need for new strategies. GLP-1 receptor agonists mimic the action of the gut hormone GLP-1, which regulates energy and sugar balance. GLP-1 receptor agonists lead to weight loss and better blood sugar control, and have shown beneficial effects on the heart and potentially the kidneys. The aim of this PhD-thesis was to investigate whether gut hormone-based medications could protect kidney function in people with obesity and chronic kidney disease, with or without type 2 diabetes. In several studies, we explored their effects on kidney function and urine protein levels, a marker of kidney damage. We also investigated whether combinations of medications, such as GLP-1 receptor agonists with SGLT2 inhibitors or drugs mimicking multiple gut hormones, provide better kidney protection and how this can be explained. The results are promising, offering hope for treating chronic kidney disease in metabolic diseases like obesity and type 2 diabetes. The final chapter discusses challenges and solutions for achieving a healthier society in the future.