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placebo in the fall of eGFR was better among patients with macroalbuminuria or in those with eGFR between 3060 ml/min/1.73 m2,100 and in the AWARD-7 trial the effect of dulaglutide on renal clinical outcomes and eGFR decline was more pronounced in participants with macroalbuminuria at baseline.66 Likewise, in a post hoc analysis of the LEADER study those patients who experienced a 30% reduction in albuminuria during follow-up had fewer cardiovascular and renal events,101 which confirms that a reduction in albuminuria is associated with a reduction in cardiovascular and renal events.99,102 Finally, the renal benefits of arGLP-1 appear to be additive to those of iSGLT2, which is of particular interest in patients with DKD.85,86,103 Cardiovascular and renal benefits of these drugs have been also demonstrated in real-life studies.104105 The causes of renal protection by some arGLP-1 s are unclear

However, further research is required to fully understand the mechanisms, safety profile, and long-term effects of this peptide combination

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Novel mechanism of endothelial nitric oxide synthase activation mediated by caveolae internalization in endothelial cells