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Adecuación y necesidad de las terapias basadas en incretinas en la enfermedad renal crónica: consenso de expertos RAND/UCLA para América Latina

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datacite.rightshttp://purl.org/coar/access_right/c_abf2
dc.contributor.authorRico-Fontalvo, Jorge
dc.contributor.authorRodrigo Daza-Arnedo
dc.contributor.authorEduardo Lorca-Herrera
dc.contributor.authorDina-Batlle, Eliana
dc.contributor.authorProenca de Moraes, Thyago
dc.contributor.authorElbert, Alicia
dc.contributor.authorBuiles-Montaño, Carlos E.
dc.contributor.authorCorrea-Rotter, Ricardo
dc.contributor.authorSánchez-Polo, Vicente
dc.date.accessioned2026-02-20T20:53:44Z
dc.date.available2026-02-20T20:53:44Z
dc.date.issued2026
dc.description.abstractAntecedentes: La evidencia que respalda a las terapias basadas en incretinas como modificadoras del riesgo renal continúa ampliándose; sin embargo, su aplicación clínica sigue siendo heterogénea entre distintos fármacos, fenotipos de enfermedad renal crónica (ERC) y sistemas de salud. En América Latina, la variabilidad en el acceso y la implementación acentúa la necesidad de una priorización guiada por fenotipos y de distinguir entre intervenciones que pueden considerarse razonables y aquellas que deben considerarse necesarias. Método: Se llevó a cabo un estudio formal de consenso de expertos utilizando el método RAND/UCLA de adecuación, reportado de acuerdo con los estándares RAND/UCLA y la guía ACCORD. Un panel multidisciplinario de expertos latinoamericanos (n = 9) evaluó la adecuación de cuatro terapias basadas en incretinas (dulaglutida, liraglutida, semaglutida y tirzepatida) en 18 escenarios clínicamente relevantes de ERC, utilizando una escala de 9 puntos en dos rondas independientes de calificación. Tras la primera ronda, se realizó una reunión presencial moderada para revisar las medianas y las distribuciones de las puntuaciones, así como para refinar la redacción de los escenarios. Las combinaciones escenario-terapia clasificadas como adecuadas tras la segunda ronda se evaluaron posteriormente en cuanto a necesidad en una tercera ronda independiente. El desacuerdo se evaluó mediante el rango interpercentílico y el rango interpercentílico ajustado por simetría, y las clasificaciones finales se establecieron según los criterios estándar RAND/UCLA. Resultados: En los 18 escenarios y las cuatro terapias evaluadas, las calificaciones de adecuación fueron más consistentemente favorables para la semaglutida y más selectivas para la tirzepatida, mientras que la dulaglutida y la liraglutida se clasificaron predominantemente como inciertas. Tras la discusión y la refinación de los escenarios, las calificaciones de la segunda ronda fueron más conservadoras y se resolvió todo el desacuerdo observado en la primera ronda. Dos escenarios orientados a la seguridad, antecedente de pancreatitis aguda y adultos mayores con fragilidad y pérdida de peso involuntaria, se clasificaron de manera uniforme como inapropiados para todas las terapias. La necesidad se estableció principalmente para la semaglutida en fenotipos cardiorrenales albuminúricos de mayor riesgo y para la tirzepatida, en escenarios seleccionados, particularmente cuando la obesidad coexistía con albuminuria persistente. En conjunto, la albuminuria, el riesgo residual a pesar de una terapia basal optimizada (bloqueo del sistema renina-angiotensina e inhibición del cotransportador sodio-glucosa tipo 2), el fenotipo metabólico y la comorbilidad cardiovascular emergieron como los principales determinantes del juicio experto. Conclusiones: En este consenso RAND/UCLA, la necesidad de terapias basadas en incretinas se concentró en fenotipos de ERC albuminúricos de alto riesgo, de forma más consistente para la semaglutida y de manera más limitada para la tirzepatida, mientras que la dulaglutida y la liraglutida se calificaron generalmente como inciertas. Estos hallazgos proporcionan un marco pragmático para apoyar la priorización terapéutica y la toma de decisiones compartida en América Latina, y ponen de relieve vacíos críticos de evidencia en la ERC avanzada, la enfermedad dependiente de diálisis y la ERC no diabética.spa
dc.description.abstractBackground: Evidence supporting incretin-based therapies as modifiers of kidney risk is expanding; however, their clinical application remains heterogeneous across agents, chronic kidney disease (CKD) phenotypes, and health care systems. In Latin America, variability in access and implementation heightens the need for phenotype-driven prioritization and for distinguishing interventions that may be considered reasonable from those that should be regarded as necessary. Method: We conducted a formal expert consensus study using the RAND/UCLA Appropriateness Method, reported in accordance with RAND/UCLA standards and the ACCORD guideline. A multidisciplinary panel of Latin American experts (n = 9) rated the appropriateness of four incretin-based therapies (dulaglutide, liraglutide, semaglutide, and tirzepatide) across 18 clinically relevant CKD scenarios using a 9-point scale in two independent rating rounds. Following Round 1, an in-person moderated meeting was held to review medians and rating distributions and to refine scenario wording. Scenario-therapy combinations classified as appropriate after Round 2 were subsequently evaluated for necessity in a third independent round. Disagreement was assessed using the interpercentile range and the interpercentile range adjusted for symmetry, with final classifications based on standard RAND/UCLA criteria. Results: Across 18 scenarios and four therapies, appropriateness ratings were most consistently favorable for semaglutide and more selective for tirzepatide, whereas dulaglutide and liraglutide were predominantly classified as uncertain. After discussion and scenario refinement, second-round ratings were more conservative, and all disagreement observed in Round 1 was resolved. Two safety-oriented scenarios: prior acute pancreatitis and older adults with frailty and unintentional weight loss, were uniformly classified as inappropriate for all therapies. Necessity was established primarily for semaglutide in albuminuric, higher-risk cardiorenal phenotypes and, for tirzepatide, in selected scenarios, particularly when obesity coexisted with persistent albuminuria. Across scenarios, albuminuria, residual risk despite optimized foundational therapy (renin-angiotensin system blockade and inhibition of sodium-glucose cotransporter type 2), metabolic phenotype, and cardiovascular comorbidity emerged as the dominant drivers of expert judgment. Conclusions: In this RAND/UCLA consensus, the necessity for incretin-based therapy was concentrated in higher-risk, albuminuric CKD phenotypes, most consistently for semaglutide and scarcer for tirzepatide, whereas dulaglutide and liraglutide were generally rated as uncertain. These findings provide a pragmatic framework to support prioritization and shared decision-making in Latin America and underscore essential evidence gaps in advanced CKD, dialysis-dependent disease, and non-diabetic CKD.eng
dc.format.mimetypepdf
dc.identifier.citationRico-Fontalvo J, et al. Adecuación y necesidad de las terapias basadas en incretinas en la enfermedad renal crónica: consenso de expertos RAND/UCLA para América Latina. Nefro Latinoam. 2026;23:1-14. doi: 10.24875/NEFRO.M26000075
dc.identifier.doihttp://dx.doi.org/10.24875/NEFRO.M26000075
dc.identifier.issn24449032 (Electrónico)
dc.identifier.urihttps://hdl.handle.net/20.500.12442/17365
dc.identifier.urlhttps://www.nefrologialatinoamericana.com/frame_esp.php?id=204
dc.language.isospa
dc.publisherSociedad Latinoamericana de Nefrología e Hipertensiónspa
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 Internationaleng
dc.rights.accessrightsinfo:eu-repo/semantics/openAccess
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.sourceNefrología Latinoamericanaspa
dc.sourceNefro Latinoam.spa
dc.sourceSupl. 1  Año 2026spa
dc.subjectEnfermedad renal crónicaspa
dc.subjectEnfermedad renal diabéticaspa
dc.subjectTerapias basadas en incretinasspa
dc.subjectAgonistas del receptor GLP-1.spa
dc.subjectTirzepatidaspa
dc.subjectSemaglutidaspa
dc.subjectMétodo de adecuación RAND/UCLAspa
dc.subjectAmérica Latinaspa
dc.subject.keywordsChronic kidney diseaseeng
dc.subject.keywordsDiabetic kidney diseaseeng
dc.subject.keywordsIncretin-based therapieseng
dc.subject.keywordsGLP-1 receptor agonistseng
dc.subject.keywordsTirzepatideeng
dc.subject.keywordsSemaglutideeng
dc.subject.keywordsRAND/UCLA Appropriateness Methodeng
dc.subject.keywordsLatin Americaeng
dc.titleAdecuación y necesidad de las terapias basadas en incretinas en la enfermedad renal crónica: consenso de expertos RAND/UCLA para América Latinaspa
dc.title.translatedAppropriateness and necessity of incretin-based therapies in chronic kidney disease: RAND/UCLA expert consensus for Latin Americaeng
dc.type.driverinfo:eu-repo/semantics/article
dc.type.spaArtículo científico
dcterms.referencesFerreiro-Fuentes A. Accessibility to kidney replacement therapy in Latin America. Semin Nephrol. 2025;45(1-2):151.eng
dcterms.referencesCorrea-Rotter R, Méndez Durán A, Vallejos A, Rico-Fontalvo J, Cusumano AM, Rosa-Diez GJ, et al. Unmet needs of CKD in Latin America: a review from Expert Virtual Working Group. Kidney Int Rep. 2023;8(5):954-67.eng
dcterms.referencesKetema DB, Wallace H, Hailu W, Badve SV, Ronksley P, Neuen BL, et al. Quality of care for people with chronic kidney disease: a systematic review and meta-analysis. BMJ Open. 2025;15(9):e102044.eng
dcterms.referencesBaker LW, Ovincy C, Souvalian L, Hickson LJ, Chebib FT. Contemporary management of advanced chronic kidney disease: an evidence-based review. Eur J Intern Med. 2026;143:106557.eng
dcterms.referencesMiramontes-González JP, Rodrigo-Alaíz Á, Gabella-Martín M, González- Calle D, Carretero-Gómez J, Corral-Gudino L. Rewriting diabetes therapy: how incretin modulation is transforming cardiovascular and renal outcomes. Diabetes Ther. 2026 Jan 5. doi: 10.1007/s13300-025-01829-1. Online ahead of print.eng
dcterms.referencesYen FS, Wei JC, Huang YH, Li PY, Tsai FJ, Hsu CC, et al. Comparative outcomes of adding SGLT-2 inhibitors versus incretin-based therapies to insulin in type 2 diabetes. Diabetes Res Clin Pract. 2025;226:112328.eng
dcterms.referencesLin R, Hsu CL, Shih MC, Chien KL, Wu HY. Comparison of the renal outcomes of novel antidiabetic agents in patients with type 2 diabetes with chronic kidney disease: a systematic review and network meta- analysis of randomized controlled trials. Diabetes Obes Metab. 2026;28(1):518-28.eng
dcterms.referencesHalimi JM, Fauchier L, Karras A, Amouyal C, Eladari D, Rossignol P, et al. Expert perspectives on incorporating GLP-1 RA in diabetes and chronic kidney disease - Challenges and opportunities. Eur J Prev Cardiol. 2026;33(1):8-18.eng
dcterms.referencesPersson F, Bain SC, Mosenzon O, Heerspink HJL, Mann JFE, Pratley R, et al. Changes in albuminuria predict cardiovascular and renal outcomes in type 2 diabetes: a post hoc analysis of the LEADER trial. Diabetes Care. 2021;44(4):1020-6.eng
dcterms.referencesPruijm M, Belmar N, Bjornstad P, Cherney DZI, Das V, Gunnarsson T, et al. REMODELing mechanistic trials for kidney disease: a multimodal, tissue-centered approach to understand the renal mechanism of action of semaglutide. Kidney Int. 2026;109(1):6-16.eng
dcterms.referencesRico-Fontalvo J, Reina M, Soler MJ, Unigarro-Palacios M, Castañeda- González JP, Quintero JJ, et al. Kidney effects of glucagon-like peptide 1 (GLP1): from molecular foundations to a pharmacophysiological perspective. J Bras Nefrol. 2024;46(4):e20240101.eng
dcterms.referencesFitch K, Bernstein SJ, Aguilar MD, Burnand B, LaCalle JR, Lazaro P, et al. RAND/UCLA appropriateness method user’s manual. Santa Monica, CA: RAND corporation; 2000.eng
dcterms.referencesGattrell WT, Logullo P, van Zuuren EJ, Price A, Hughes EL, Blazey P, et al. ACCORD (ACcurate COnsensus Reporting Document): a reporting guideline for consensus methods in biomedicine developed via a modified Delphi. PLoS Med. 2024;21(1):e1004326eng
dcterms.referencesKDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024;105(4s):S117-S314.eng
dcterms.referencesMuta Y, Kobayashi K, Toyoda M, Tsukamoto S, Tsuriya D, Takashi Y, et al. Influence of combination therapy with dulaglutide or liraglutide and SGLT-2 inhibitors on renal outcomes in patients with type 2 diabetes: a post-hoc analysis of the RECAP study. Tokai J Exp Clin Med. 2025;50(1):1-9.eng
dcterms.referencesDai JW, Lin Y, Li XW, Tseng CJ, Tsai ML, Yang NI, et al. Comparative cardiovascular and renal outcomes of Liraglutide versus Dulaglutide in Asian type 2 diabetes patients. Sci Rep. 2024;14(1):27491.eng
dcterms.referencesClegg LE, Penland RC, Bachina S, Boulton DW, Thuresson M, Heerspink HJL, et al. Effects of exenatide and open-label SGLT-2 inhibitor treatment, given in parallel or sequentially, on mortality and cardiovascular and renal outcomes in type 2 diabetes: insights from the EXSCEL trial. Cardiovasc Diabetol. 2019;18(1):138.eng
dcterms.referencesCai YX, Liu FH, Sun JH, Lin CH. The cardiovascular outcomes between liraglutide and dulaglutide among different chronic kidney disease stages in patients with type 2 diabetes. Endocr Pract. 2025;31(3):292-7.eng
dcterms.referencesColhoun HM, Lingvay I, Brown PM, Deanfield J, Brown-Frandsen K, Kahn SE, et al. Long-term kidney outcomes of semaglutide in obesity and cardiovascular disease in the SELECT trial. Nat Med. 2024;30(7):2058-66.eng
dcterms.referencesApperloo EM, Gorriz JL, Soler MJ, Cigarrán Guldris S, Cruzado JM, Puchades MJ, et al. Semaglutide in patients with overweight or obesity and chronic kidney disease without diabetes: a randomized double-blind placebo-controlled clinical trial. Nat Med. 2025;31(1):278-85.eng
dcterms.referencesPerkovic V, Tuttle KR, Rossing P, Mahaffey KW, Mann JFE, Bakris G, et al. Effects of semaglutide on chronic kidney disease in patients with type 2 diabetes. N Engl J Med. 2024;391(2):109-21.eng
dcterms.referencesMcGuire DK, Marx N, Mulvagh SL, Deanfield JE, Inzucchi SE, Pop-Busui R, et al. Oral semaglutide and cardiovascular outcomes in high-risk type 2 diabetes. N Engl J Med. 2025;392(20):2001-12.eng
dcterms.referencesGerstein HC, Colhoun HM, Dagenais GR, Diaz R, Lakshmanan M, Pais P, et al. Dulaglutide and renal outcomes in type 2 diabetes: an exploratory analysis of the REWIND randomised, placebo-controlled trial. Lancet. 2019;394(10193):131-8.eng
dcterms.referencesTuttle KR, McKinney TD, Davidson JA, Anglin G, Harper KD, Botros FT. Effects of once-weekly dulaglutide on kidney function in patients with type 2 diabetes in phase II and III clinical trials. Diabetes Obes Metab. 2017;19(3):436-41.eng
dcterms.referencesTuttle KR, Lakshmanan MC, Rayner B, Busch RS, Zimmermann AG, Woodward DB, et al. Dulaglutide versus insulin glargine in patients with type 2 diabetes and moderate-to-severe chronic kidney disease (AWARD-7): a multicentre, open-label, randomised trial. Lancet Diabetes Endocrinol. 2018;6(8):605-17.eng
dcterms.referencesTuttle KR, Rayner B, Lakshmanan MC, Kwan AYM, Konig M, Shurzinske L, et al. Clinical outcomes by albuminuria status with dulaglutide versus insulin glargine in participants with diabetes and CKD: AWARD-7 Exploratory Analysis. Kidney360. 2021;2(2):254-62.eng
dcterms.referencesMarso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JF, Nauck MA, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016;375(4):311-22.eng
dcterms.referencesDavies MJ, Bain SC, Atkin SL, Rossing P, Scott D, Shamkhalova MS, et al. Efficacy and safety of liraglutide versus placebo as add-on to glucose- lowering therapy in patients with type 2 diabetes and moderate renal impairment (LIRA-RENAL): a randomized clinical trial. Diabetes Care. 2016;39(2):222-30.eng
dcterms.referencesvon Scholten BJ, Persson F, Rosenlund S, Hovind P, Faber J, Hansen TW, et al. The effect of liraglutide on renal function: a randomized clinical trial. Diabetes Obes Metab. 2017;19(2):239-47.eng
dcterms.referencesBancalari A, Berlinski SG, Buitrago G, García MF, De la Mata D, Vera- Hernández M. Health systems and health inequalities in Latin America. IDB Working Paper Series; 2023.eng
dcterms.referencesTelles JP, Tuon F, Cunha A, Rocha JLL. The burden of limited resources in Latin America on healthcare quality and management. Lancet Reg Health Am. 2025;43:101014.eng
dcterms.referencesKepp KP, Aavitsland P, Ballin M, Balloux F, Baral S, Bardosh K, et al. Panel stacking is a threat to consensus statement validity. J Clin Epidemiol. 2024;173:111428.eng
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