Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun 17;20(8):1100-1110.
doi: 10.2215/CJN.0000000750.

GLP-1 Receptor Agonist Outcomes, Safety, and Body Mass Index Change in a National Cohort of Patients on Dialysis

Babak J Orandi  1   2 , Yusi Chen  1 , Yiting Li  1 , David Charytan  2 , Krista L Lentine  3 , Brian P Lee  4   5 , Nicole Ali  2 , Mario P DeMarco  6 , Michael A Weintraub  2 , Sunjae Bae  1 , Bonnie E Lonze  1 , Christine J Ren-Fielding  1 , Holly Lofton  2 , Akash Gujral  1 , Dorry L Segev  1   4 , Mara McAdams-DeMarco  1   4
Affiliations

GLP-1 Receptor Agonist Outcomes, Safety, and Body Mass Index Change in a National Cohort of Patients on Dialysis

Babak J Orandi et al. Clin J Am Soc Nephrol. .

Abstract

Key Points:

  1. GLP-1 receptor agonists (GLP-1 RAs) in diabetes and dialysis are associated with 23% lower mortality and 66% higher chance of transplant waitlisting.

  2. GLP-1 RAs are not associated with increased risk of acute pancreatitis, biliary complications, or medullary thyroid cancer.

  3. GLP-1 RAs are associated with a 32% increased risk of diabetic retinopathy in patients with diabetes on dialysis.

Background: Of the 808,000 US patients on dialysis, 60% have diabetes and are eligible for glucagon-like peptide-1 receptor agonists (GLP-1 RAs). Safety and outcomes in this population are unknown. We sought to examine GLP-1 RA real-world safety, efficacy, and weight loss in people with diabetes on dialysis.

Methods: In this observational national cohort study (2013–2021), we identified adults with type 2 diabetes on dialysis. The exposure of interest was GLP-1 RA use. Body mass index (BMI) change after dialysis initiation was quantified among patients with two measurements (N=6474). Extended Cox models with inverse probability of treatment weights (censoring for kidney transplant waitlisting) were used to quantify all-cause mortality associated with GLP-1 RAs. Specific safety outcomes (acute pancreatitis, biliary complications, medullary thyroid cancer, and diabetic retinopathy) were assessed.

Results: The study included 151,649 patients on incident dialysis with type 2 diabetes. Mean BMI and weight change among GLP-1 RA users were greater than those among nonusers (−1.47 versus −0.61 kg/m2; −4.03 versus −1.47 kg; P < 0.001 for both). The mortality incidence rate was lower among GLP-1 RA users (219.0 versus 279.5 patients/1000 person-years; P < 0.001). GLP-1 RA use was associated with a 23% lower risk of mortality (adjusted hazard ratio [aHR], 0.77; 95% confidence interval [CI], 0.70 to 0.85; P < 0.001); results were consistent among initiates with BMI ≥30 kg/m2. GLP-1 RA use was associated with a 66% higher chance of waitlisting (aHR, 1.66; 95% CI, 1.28 to 2.13; P < 0.001). There was an increased association with diabetic retinopathy (aHR, 1.32; 95% CI, 1.12 to 1.56; P = 0.001), but not with any other safety outcomes. Inferences were consistent across multiple sensitivity analyses.

Conclusions: GLP-1 RA use in patients with type 2 diabetes on dialysis was associated with weight loss, reduced mortality risk, and increased likelihood of kidney transplant waitlisting. These real-world data are the strongest evidence to date supporting GLP-1 RA use in this population.

Keywords: ESKD.

PubMed Disclaimer

Conflict of interest statement

Disclosure forms, as provided by each author, are available with the online version of the article at http://links.lww.com/CJN/C318.

References

    1. Frías JP Davies MJ Rosenstock J, et al. Tirzepatide versus semaglutide once weekly in patients with type 2 diabetes. N Engl J Med. 2021;385(6):503–515. doi: 10.1056/NEJMoa2107519 - DOI - PubMed
    1. Sorli C Harashima SI Tsoukas GM, et al. Efficacy and safety of once-weekly semaglutide monotherapy versus placebo in patients with type 2 diabetes (SUSTAIN 1): a double-blind, randomised, placebo-controlled, parallel-group, multinational, multicentre phase 3a trial. Lancet Diabetes Endocrinol. 2017;5(4):251–260. doi: 10.1016/S2213-8587(17)30013-X - DOI - PubMed
    1. Wysham C Blevins T Arakaki R, et al. Efficacy and safety of dulaglutide added onto pioglitazone and metformin versus exenatide in type 2 diabetes in a randomized controlled trial (AWARD-1). Diabetes Care. 2014;37(8):2159–2167. doi: 10.2337/dc13-2760 - DOI - PubMed
    1. Davies M, Pieber TR, Hartoft-Nielsen ML, Hansen OKH, Jabbour S, Rosenstock J. Effect of oral semaglutide compared with placebo and subcutaneous semaglutide on glycemic control in patients with type 2 diabetes: a randomized clinical trial. JAMA. 2017;318(15):1460–1470. doi: 10.1001/jama.2017.14752 - DOI - PMC - PubMed
    1. Davies MJ Bergenstal R Bode B, et al. Efficacy of liraglutide for weight loss among patients with type 2 diabetes: the SCALE diabetes randomized clinical trial. JAMA. 2015;314(7):687–699. doi: 10.1001/jama.2015.9676 - DOI - PubMed

LinkOut - more resources