Clinical, Morphometric and Biochemical Effects on Adiposopathy Associated With the Use of GLP-1RA in CKD
NCT ID: NCT07309094
Last Updated: 2025-12-30
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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RECRUITING
250 participants
OBSERVATIONAL
2023-09-15
2028-12-31
Brief Summary
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The aim of this study is to assess the link between adiposopathy and CKD, by investigating the changes in adiposopathy measures throughout treatment with GLP-1RA to a sample of patients with CKD.
Detailed Description
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Adiposopathy is a key driver of cardiorenal risk in CKD. Evidence from bioimpedance, imaging techniques (CT, MRI), and molecular biology studies confirm that alterations in adipose tissue-including its quantity, distribution (e.g., perirenal, epicardial), radiodensity, and the secretion of pro-inflammatory adipokines-are powerful triggers of cardiorenal damage and mortality in these patients. This understanding frames obesity, T2DM, cardiovascular diseases (CVDs), and CKD as different manifestations of a shared spectrum, now termed adiposity-based chronic disease (ABCD), necessitating an "adipocentric" therapeutic approach.
One hallmark feature of adiposopathy is the reprogramming and increase in size of certain region-specific adipose tissue. Perivisceral adipose tissue plays a pivotal role in adiposity-based chronic diseases as it releases adipokines and cytokines that not only contribute to the systemic pro-inflammatory and oxidative stress processes but may also influence the function of the organs surrounded by this tissue.
GLP-1RA stimulates the receptor for glucagon-like peptide-1 (GLP-1), an incretin-like hormone released in the large intestine that reduces serum glucose concentrations by stimulating the glucose-dependent release of insulin, inhibiting the hypersecretion of glucagon (except in hypoglycemia periods) and promoting satiety. GLP-1RA reduced the incidence of cardiovascular death in patients with T2DM compared with placebo and decreased the incidence of major kidney events, also reducing the progression of kidney dysfunction and the risk of death. In animals, the observed morphological changes generated by GLP-1RA could be underlined by potential actions on adipose tissue remodeling, as these drugs upregulated the expression of AT-browning related genes in perivisceral white adipose tissue from murine models, although the transcriptomic effects from GLP-1RA on the adiposopathy process are still unknown.
Conditions
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Keywords
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Study Design
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COHORT
PROSPECTIVE
Study Groups
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GLP-1RA Cohort
Patients receiving GLP-1RA, mainly semaglutide: weekly administration, subcutaneous form, from 0.25mg (starting dose) to 1mg (maintenance dose) with monthly increase (0.25-0.5-1mg)
GLP-1 receptor agonist
Semaglutide: weekly subcutaneous administration, starting dose 0.25mg, maintenance dose 1mg
SGLT2 inhibitor
dapagliflozin: oral administration from 5 to 10mg/day
SGLT2i Cohort
There will also be another comparative group of patients under SGLT2i
GLP-1 receptor agonist
Semaglutide: weekly subcutaneous administration, starting dose 0.25mg, maintenance dose 1mg
SGLT2 inhibitor
dapagliflozin: oral administration from 5 to 10mg/day
Other treatments
Patients not under SGLT2i or GLP-1RA/Tirzepatide influence, but receiving other treatments that are part of CKD and diabetes standard care
No interventions assigned to this group
Dual GIP GLP-1RA
Patients receiving tirzepatide: weekly administration, subcutaneous form, starting dose 2.5mg, maintenance 5mg
Tirzepatide
subcutaneous injection: starting dose 2.5 mg, maintenance 5mg (weekly administration)
Other drugs
Patients not under SGLT2i or GLP-1RA influence, but receiving other treatments which are part of CKD standard care: mineralocorticoid receptor agonists, metformin, ACE inhibitors, ARBs...
Interventions
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GLP-1 receptor agonist
Semaglutide: weekly subcutaneous administration, starting dose 0.25mg, maintenance dose 1mg
SGLT2 inhibitor
dapagliflozin: oral administration from 5 to 10mg/day
Tirzepatide
subcutaneous injection: starting dose 2.5 mg, maintenance 5mg (weekly administration)
Other drugs
Patients not under SGLT2i or GLP-1RA influence, but receiving other treatments which are part of CKD standard care: mineralocorticoid receptor agonists, metformin, ACE inhibitors, ARBs...
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
* diagnosed with CKD in stages G1, G2, G3a, G3b, and G4, not candidate for dialysis
* had uncontrolled T2DM, CVDs and/or obesity
* willing to participate in the study and sign informed consent
Exclusion Criteria
* pregnancy
* CKD in stage G5 or G4 candidate for dialysis
* neuropsychiatric diseases preventing the patient from understanding the benefits/risks associated with the project
18 Years
90 Years
ALL
No
Sponsors
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Cardenal Herrera University
OTHER
Responsible Party
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Ana Checa-Ros
Co-PI. PhD Lecturer
Principal Investigators
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Luis D'Marco, MD, PhD
Role: PRINCIPAL_INVESTIGATOR
Cardenal Herrera University
Ana Checa-Ros, MD, PhD
Role: PRINCIPAL_INVESTIGATOR
Cardenal Herrera University
Locations
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Vithas Valencia Consuelo
Valencia, Valencia, Spain
Countries
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Central Contacts
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Facility Contacts
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Luis D'Marco, MD, PhD
Role: primary
References
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Zhao L, Li W, Zhang P, Wang D, Yang L, Yuan G. Liraglutide induced browning of visceral white adipose through regulation of miRNAs in high-fat-diet-induced obese mice. Endocrine. 2024 Jul;85(1):222-232. doi: 10.1007/s12020-024-03734-2. Epub 2024 Feb 20.
Ying Y, Zhu H, Liang Z, Ma X, Li S. GLP1 protects cardiomyocytes from palmitate-induced apoptosis via Akt/GSK3b/b-catenin pathway. J Mol Endocrinol. 2015 Dec;55(3):245-62. doi: 10.1530/JME-15-0155. Epub 2015 Sep 18.
Carraro-Lacroix LR, Malnic G, Girardi AC. Regulation of Na+/H+ exchanger NHE3 by glucagon-like peptide 1 receptor agonist exendin-4 in renal proximal tubule cells. Am J Physiol Renal Physiol. 2009 Dec;297(6):F1647-55. doi: 10.1152/ajprenal.00082.2009. Epub 2009 Sep 23.
Perkovic V, Tuttle KR, Rossing P, Mahaffey KW, Mann JFE, Bakris G, Baeres FMM, Idorn T, Bosch-Traberg H, Lausvig NL, Pratley R; FLOW Trial Committees and Investigators. Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes. N Engl J Med. 2024 Jul 11;391(2):109-121. doi: 10.1056/NEJMoa2403347. Epub 2024 May 24.
Giugliano D, Maiorino MI, Bellastella G, Longo M, Chiodini P, Esposito K. GLP-1 receptor agonists for prevention of cardiorenal outcomes in type 2 diabetes: An updated meta-analysis including the REWIND and PIONEER 6 trials. Diabetes Obes Metab. 2019 Nov;21(11):2576-2580. doi: 10.1111/dom.13847. Epub 2019 Aug 28.
D'Marco L, Puchades MJ, Panizo N, Romero-Parra M, Gandia L, Gimenez-Civera E, Perez-Bernat E, Gonzalez-Rico M, Gorriz JL. Cardiorenal Fat: A Cardiovascular Risk Factor With Implications in Chronic Kidney Disease. Front Med (Lausanne). 2021 May 25;8:640814. doi: 10.3389/fmed.2021.640814. eCollection 2021.
Ku E, Lee BJ, Wei J, Weir MR. Hypertension in CKD: Core Curriculum 2019. Am J Kidney Dis. 2019 Jul;74(1):120-131. doi: 10.1053/j.ajkd.2018.12.044. Epub 2019 Mar 19.
Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010 Jan;87(1):4-14. doi: 10.1016/j.diabres.2009.10.007. Epub 2009 Nov 6.
Khan MZ, Syed M, Osman M, Faisaluddin M, Sulaiman S, Farjo PD, Khan MU, Agrawal P, Alharbi A, Khan SU, Munir MB, Balla S. Contemporary Trends and Outcomes in Patients With ST-Segment Elevation Myocardial Infarction and End-Stage Renal Disease on Dialysis: Insight from the National Inpatient Sample. Cardiovasc Revasc Med. 2020 Dec;21(12):1474-1481. doi: 10.1016/j.carrev.2020.05.004. Epub 2020 May 11.
Moisi MI, Bungau SG, Vesa CM, Diaconu CC, Behl T, Stoicescu M, Toma MM, Bustea C, Sava C, Popescu MI. Framing Cause-Effect Relationship of Acute Coronary Syndrome in Patients with Chronic Kidney Disease. Diagnostics (Basel). 2021 Aug 23;11(8):1518. doi: 10.3390/diagnostics11081518.
Artzi-Medvedik R, Kob R, Fabbietti P, Lattanzio F, Corsonello A, Melzer Y, Roller-Wirnsberger R, Wirnsberger G, Mattace-Raso F, Tap L, Gil P, Martinez SL, Formiga F, Moreno-Gonzalez R, Kostka T, Guligowska A, Arnlov J, Carlsson AC, Freiberger E, Melzer I; SCOPE investigators. Impaired kidney function is associated with lower quality of life among community-dwelling older adults : The screening for CKD among older people across Europe (SCOPE) study. BMC Geriatr. 2020 Oct 2;20(Suppl 1):340. doi: 10.1186/s12877-020-01697-3.
George LK, Koshy SKG, Molnar MZ, Thomas F, Lu JL, Kalantar-Zadeh K, Kovesdy CP. Heart Failure Increases the Risk of Adverse Renal Outcomes in Patients With Normal Kidney Function. Circ Heart Fail. 2017 Aug;10(8):e003825. doi: 10.1161/CIRCHEARTFAILURE.116.003825.
GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020 Feb 29;395(10225):709-733. doi: 10.1016/S0140-6736(20)30045-3. Epub 2020 Feb 13.
Foreman KJ, Marquez N, Dolgert A, Fukutaki K, Fullman N, McGaughey M, Pletcher MA, Smith AE, Tang K, Yuan CW, Brown JC, Friedman J, He J, Heuton KR, Holmberg M, Patel DJ, Reidy P, Carter A, Cercy K, Chapin A, Douwes-Schultz D, Frank T, Goettsch F, Liu PY, Nandakumar V, Reitsma MB, Reuter V, Sadat N, Sorensen RJD, Srinivasan V, Updike RL, York H, Lopez AD, Lozano R, Lim SS, Mokdad AH, Vollset SE, Murray CJL. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016-40 for 195 countries and territories. Lancet. 2018 Nov 10;392(10159):2052-2090. doi: 10.1016/S0140-6736(18)31694-5. Epub 2018 Oct 16.
Borg R, Carlson N, Sondergaard J, Persson F. The Growing Challenge of Chronic Kidney Disease: An Overview of Current Knowledge. Int J Nephrol. 2023 Mar 1;2023:9609266. doi: 10.1155/2023/9609266. eCollection 2023.
Study Documents
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Document Type: Statistical Analysis Plan
View DocumentDocument Type: Analytic Code
View DocumentRelated Links
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Other Identifiers
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23/424
Identifier Type: -
Identifier Source: org_study_id