GLP1R and chronic kidney disease: 5.We recommend caution for the use of GLP-1 RA or GLP-1 RA/GIP RA dual agonists in people with CKD with advanced active diabetic retinopathy (proliferative diabetic retinopathy) and elevated HbA1c (>86 mmol/mol or 10%) and if treatment is started, avoidance of rapid reduction in HbA1c and liaising with ophthalmology teams to ensure retinal surveillance is in place (expert opinion no high grade evidence).