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The signal for acute kidney injury (675 cases) was more prominent in elderly and overweight groups, potentially linked to metformins contraindication in renal impairment 34 and the dehydration effects of GLP-1RAs 40 , highlighting the need for strict baseline renal function screening and monitoring of blood volume status

Mechanisms identified include: increased cardiac utilization of ketones increased autophagy (recycling of intracellular components)l decreased inflammation & oxidative stress improved mitochondrial function decreased intracellular Ca & Na overload decreased fibrosis improved myocardial diastolic function decrease myocardial hypertrophy Figure 1

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doi: 10.3389/fmolb.2021.659550 45 SoaresN