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Data Items Collected The following variables were charted for each included source of evidence: Bibliographic information: author, year, country, funding Study characteristics: design, phase, sample size, duration, setting Population: diabetes type, overweight/obesity definitions, CKD stage, albuminuria status, baseline eGFR, concomitant therapies Intervention(s) or exposure: GLP-1 receptor agonist or tirzepatide (dose, route, duration) Comparator(s): placebo or active comparator Outcomes: kidney and cardiorenal measures (eGFR slope, composite renal endpoints, albuminuria, safety) Main findings: direction and magnitude of renal effect Appraisal and evidence rating: methodological quality, certainty, and relevance Notes: contextual remarks, analytic subgroups, and comments on applicability Appraisal and Evidence Rating Because this review was conducted to inform the RAND/UCLA Appropriateness Method for SLANH, each included study underwent a structured critical appraisal using the appropriate validated tool for its design: Randomized controlled trials: Cochrane Risk of Bias 2 (RoB 2) [10] Post hoc or secondary RCT analyses: adapted Cochrane or NIH tool Observational comparative studies: ROBINS-I [11] The AI tool was programmed to assist in pre-classifying bias domains (e.g., randomization, blinding, confounding) and to highlight textual evidence for reviewer judgment

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Patients prescribed GLP-1 therapies often differ in baseline characteristics from those receiving alternative medications