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). The gene discussed is GLP1R; the disease is proliferative diabetic retinopathy.