From the Guidelines
GLP-1 receptor agonists can be used in patients on hemodialysis, but with careful consideration and potential dose adjustments, as they have been shown to reduce albuminuria and slow eGFR decline, and may offer cardiovascular benefits 1.
Key Considerations
- Medications like semaglutide, dulaglutide, and liraglutide may be prescribed for dialysis patients, though some require dose adjustments.
- These medications work by increasing insulin secretion, reducing glucagon, and slowing gastric emptying, which helps control blood sugar without increasing hypoglycemia risk.
- Patients should be monitored for side effects like nausea, vomiting, and potential volume depletion, which could be problematic during dialysis.
- Always consult with both your nephrologist and endocrinologist before starting these medications, as individual factors including dialysis schedule, residual kidney function, and other medications need consideration.
Benefits and Risks
- GLP-1 receptor agonists have been shown to reduce the risk of major adverse cardiovascular events (MACE) in patients with type 2 diabetes, and may offer similar benefits for dialysis patients 1.
- However, they may also increase the risk of nausea, vomiting, and diarrhea, which can be problematic for patients on hemodialysis.
- The use of GLP-1 receptor agonists in patients on hemodialysis should be carefully weighed against the potential benefits and risks, and individualized to each patient's needs and medical history.
Dosing and Administration
- Semaglutide typically does not require dose adjustment in patients with renal impairment, while exenatide is not recommended in severe renal impairment 1.
- Dulaglutide can be used in patients with eGFR > 15 ml/min/1.73 m², and may require dose adjustment in patients with more severe renal impairment 1.
- Liraglutide may also be used in patients with renal impairment, but the optimal dosing and administration strategy is not well established 1.
From the FDA Drug Label
5.6 Acute Kidney Injury There have been postmarketing reports of acute kidney injury and worsening of chronic renal failure, which may sometimes require hemodialysis, in patients treated with GLP-1 receptor agonists.
The FDA drug label does not provide information on whether GLP-1 can be taken on hemodialysis. It only mentions that GLP-1 receptor agonists may cause acute kidney injury or worsening of chronic renal failure, which may require hemodialysis. Key points:
- GLP-1 receptor agonists may cause acute kidney injury or worsening of chronic renal failure.
- The label does not provide guidance on taking GLP-1 on hemodialysis. 2
From the Research
GLP-1 Receptor Agonists and Hemodialysis
- GLP-1 receptor agonists, such as semaglutide, can be used in patients with advanced-stage chronic kidney disease (CKD) 3.
- The European Medicines Agency has approved the use of all commercially available human GLP-1 analogs up to a minimal eGFR of 15 mL/min/1.73 m2 3.
- Studies have shown that GLP-1 receptor agonists can be effective in improving glycemic control, lowering HbA1c, albuminuria, weight, and blood pressure control in patients with type 2 diabetes on hemodialysis 3, 4.
Safety and Efficacy of GLP-1 Receptor Agonists in Hemodialysis Patients
- A case series study found that semaglutide was effective and safe in patients with advanced diabetic kidney disease on maintenance incremental hemodialysis 3.
- Another study found that semaglutide and liraglutide had kidney-protective effects in patients with type 2 diabetes, which appeared more pronounced in patients with preexisting chronic kidney disease 4.
- The effects of GLP-1 receptor agonists on cardiovascular and renal outcomes were found to be similar across different body mass index categories in patients with type 2 diabetes 5.
Use of GLP-1 Receptor Agonists in Patients with Type 2 Diabetes on Hemodialysis
- GLP-1 receptor agonists, such as semaglutide, can be considered as a treatment option for patients with type 2 diabetes on hemodialysis who require treatment intensification 3, 6.
- Oral semaglutide has been shown to be effective in reducing HbA1c and body weight in patients with type 2 diabetes on insulin therapy, and may be a useful alternative to injectable GLP-1 receptor agonists 6.