The Effects of GLP-1RA-Based and SGLT2 Inhibitor Therapy on Perirenal Adipose Tissue in CKD Patients
- Design
- Prospective cohort · 80 participants · Biomarker outcome
- Match to healthy normal-weight adults aged 55–75
- Population unclearUNKNOWN: adults with CKD Stages 1-4; the abstract reports no BMI or diabetes status (only a body-weight range of 46-122 kg) and no age.
- Could weight loss explain it?
- PossiblyGLP-1RA-based therapy lowered body weight, fat mass and visceral fat area. The authors report that PRAT change correlated with none of these and conclude the fall was not explained by measured body-composition change, but a correlation of changes is not a formal mediation analysis or a weight-matched comparison, so weight and metabolic change are not excluded as contributors.
- Study tier
- Study tier 3LOW: a single small prospective observational cohort (24 patients on GLP-1RA-based therapy) with an imaging-biomarker outcome.
- Assessment
- Version 3 · Two reviewers differed; settled by a recorded ruling · Oct 19, 2026
Study facts come from the paper. Population match, weight-loss explanation and study tier are our judgments, made against the reference group of healthy normal-weight adults aged 55–75.
In a prospective cohort of adults with chronic kidney disease, 80 had kidney ultrasound at baseline and at an 8-month visit. GLP-1 receptor agonist-based therapy was associated with a thinner layer of fat around the kidneys than in patients on neither drug class (adjusted difference -0.433 cm), and SGLT2 inhibitors with a smaller difference whose interval included no difference under multiple imputation. The change did not correlate with weight or fat loss. This is a small observational study of a fat-depot measure, so it shows an association, not a clinical benefit.
01Findings
What the study reported
- Drugs
- Glp-1 receptor agonists
- Comparator
- reference group receiving neither drug class; SGLT2 inhibitors
- Dose
- various
- Primary outcome
- Change in ultrasound-measured perirenal adipose tissue (PRAT) thickness
- Effect
- GLP-1RA-based therapy versus reference: adjusted difference -0.433 cm (-0.622 to -0.244); under multiple imputations -0.421 cm (-0.693 to -0.149). Within-group PRAT change -0.463 cm (-36.2%, p < 0.0001) with GLP-1RA-based therapy and +0.035 cm (p = 0.376) in the reference group. SGLT2i versus reference -0.227 cm (95% CI -0.417 to -0.036); -0.218 cm (-0.482 to +0.046) under multiple imputations.
- 95% confidence interval
- -0.622 to -0.244 cm (adjusted difference versus reference, GLP-1RA-based therapy; level not stated for this interval)
- P value
- p < 0.0001 (within-group change, GLP-1RA-based therapy); no p value given for the between-group difference
- Follow-up
- 8 months
- Adverse events
- not reported in abstract
- Limitations
- Small, non-randomised observational cohort (80 of 277 patients had paired scans, 24 on GLP-1RA-based therapy) with an imaging-biomarker outcome; under multiple imputation the SGLT2i interval included no difference.
Who was studied
- Obesity status
- not reported in abstract
- Diabetes status
- not reported in abstract
- Cvd status
- not reported in abstract
- Ckd status
- CKD required (Stages 1-4)
- Baseline condition
- Chronic kidney disease, Stages 1-4
- Sample size
- 80
- Inclusion exclusion
- adults with CKD stages 1-4 in the ADIPO-CKD cohort with paired ultrasound studies; body weight 46-122 kg
Study quality details
- Study design
- Prospective cohort
- Sample size
- 80
- Randomization
- no
- Blinding
- n/a
- Comparator
- reference group receiving neither drug class; SGLT2 inhibitors
- Follow up duration
- 8 months
- Outcome type
- biomarker
- Replication
- not assessed
- Consistency with other evidence
- not assessed
- Population applicability
- UNKNOWN
- Statistical precision
- CI reported: -0.622 to -0.244 cm (adjusted difference versus reference, GLP-1RA-based therapy; level not stated for this interval)
- Risk of bias
- not assessed
- Funding conflicts
- unclear
- Peer review status
- yes
02Funding
Funding and conflicts
- Funding
- not reported in abstract
- Industry funded
- Unclear
- Manufacturer
- not stated in source
- Sponsor role
- not reported in abstract
- Author conflicts
- not reported in abstract
- Independent replication
- unknown
Funding is shown on every study and never used to score it.
04Source
The source, as retrieved
Abstract
[AIMS] Perirenal adipose tissue (PRAT) surrounds the kidney and may contribute to chronic kidney disease (CKD) progression. SGLT2 inhibitors have been associated with reductions in this depot, but PRAT has not been quantified under GLP-1RA-based therapy in CKD. We assessed ultrasound-measured PRAT thickness under both treatments and whether changes tracked weight loss. [MATERIALS AND METHODS] Adults with CKD Stages 1-4 in the prospective ADIPO-CKD inception cohort underwent ultrasound at baseline and at the 8-month visit. PRAT thickness was the mean of right and left measurements; epicardial adipose tissue and body composition were also assessed. Patients received neither drug class (reference), SGLT2i or GLP-1RA-based therapy. Follow-up PRAT was analysed by covariance analysis adjusted for baseline. [RESULTS] Of 277 patients, 80 had paired studies (32 reference, 24 SGLT2i, 24 GLP-1RA-based; body weight 46-122 kg). PRAT was unchanged in the reference group (+0.035 cm, p = 0.376) and decreased with SGLT2i (-0.273 cm, -20.4%, p = 0.0006) and GLP-1RA-based therapy (-0.463 cm, -36.2%, p < 0.0001). Adjusted differences versus reference were -0.227 cm (95% CI -0.417 to -0.036) and -0.433 cm (-0.622 to -0.244); under multiple imputations, -0.218 cm (-0.482 to +0.046) and -0.421 cm (-0.693 to -0.149). GLP-1RA-based therapy reduced body weight, fat mass and visceral fat area; SGLT2i only body weight, modestly. PRAT change correlated with none. [CONCLUSIONS] In CKD, both drug classes were associated with lower follow-up PRAT, not explained by measured body-composition change. Under multiple imputations, both estimates were essentially unchanged, though the SGLT2i interval included no difference. PRAT may represent a candidate depot-specific target. [TRIAL REGISTRATION] ClinicalTrials.gov identifier: NCT07309094 (ADIPO-CKD).