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David Cherney, MD, PhD, FRCPC, covered the standard of care for managing chronic kidney disease (CKD) in people with diabetes and elaborated on the role of GLP-1RA–based therapies. His key takeaway focused on the current therapeutic pillars (RAS blockers, SGLT2 inhibitors, and finerenone) for managing CKD, where GLP-1RA based therapies are acting as the new pillar. He discussed the FLOW trial, which measured the efficacy of semaglutide on renal outcomes.
Compared with other medicines used for treating diabetes, such as SGLT2 inhibitors, GLP-1RAs and other newer CKD therapies address the cardio-kidney-metabolic overlap — a truly exciting development. Cherney highlighted that albuminuria and eGFR screening will become more common as use of GLP-1 therapies increases; in fact, he predicted they will become standard of care in high-risk patients, so that individuals with a CKD indication are adequately treated. Cherney emphasized that further research is needed in other patient groups, especially those with type 1 diabetes and non-diabetic CKD. Though trials are ongoing in these fields, a tremendous need remains.
Next, Christos Mantzoros, MD, DSc, PhD, presented a background on adipose tissue and the history of leptin and GLP-1RAs, including their emergence as highly promising treatments for obesity, type 2 diabetes, and associated comorbidities. A key takeaway was that use of GLP-1RAs must be accompanied by a proactive evaluation of broader metabolic and systemic impacts. For example, Mantzoros’s lab is generating real-world evidence on how these novel therapies affect behavioral shifts around eating, such as food preferences and dietary patterns.
Since GLP-1RAs affect multiple systems, Mantzoros emphasized the need for continuous collaboration among clinical laboratory professionals and clinicians across disciplines. Ensuring the safe and effective use of GLP-1RAs involves identifying the best baseline blood work prior to treatment initiation and the establishment of monitoring strategies during therapy to track metabolic changes, liver function, and nutritional status.
The next frontier for GLP-1RAs is for treating metabolic dysfunction-associated steatohepatitis (MASH), a rapidly expanding, largely silent driver of cardio-metabolic disease, liver failure, and escalating healthcare costs. Timely, stage-specific detection of MASH patients is critical, since patients with moderate-to-advanced fibrosis (F2-F3) are eligible for the newly approved therapeutic resmetirom, a liver targeting thyroid hormone receptor-β (THRβ) selective agonist and expanding use of GLP-1RA in clinical trials to treat MASH. Current diagnostic methods (invasive biopsy or existing non-invasive tests) lack the accuracy to reliably detect MASH F2-F3 separately from F4.
Mantzoros’s lab established and independently validated a clinical-metabolomics–based F2-F3 liquid biopsy that outperforms all other noninvasive tests. The biopsy integrates up to three routine clinical variables and metabolomic markers, achieving excellent accuracy (AUC=0.94), specificity (97%), and positive predictive value (PPV=92%). Mantzoros and team have also developed a cirrhosis (F4) exclusion liquid biopsy that leverages five standard clinical laboratory metrics and one hormone, yielding high accuracy (96%). Their data strongly suggest this novel liquid biopsy can significantly reduce misclassification, unnecessary biopsies, and associated healthcare expenditures.
There is clearly growing interest in exploring GLP-1RAs for a wide range of clinical conditions beyond diabetes and obesity, including MASH, kidney disorders, neurodegenerative diseases, and even arthritis. The future looks promising, and those who attended this session left with a greater understanding of how patients may benefit from more effective and comprehensive disease management, including specialized laboratory tests.
