From the Guidelines
Ozempic (semaglutide) can be considered for use in kidney transplant patients with diabetes or obesity, but it requires close monitoring by a transplant specialist due to potential interactions with immunosuppressive medications and effects on kidney function, as suggested by the most recent evidence 1.
Key Considerations
- The medication may be prescribed for kidney transplant recipients, but dosing typically starts at a lower level (0.25mg weekly) with gradual increases based on tolerance.
- Kidney transplant patients should have their kidney function, immunosuppressant drug levels, and blood glucose regularly monitored while taking Ozempic.
- The medication can potentially interact with immunosuppressive medications like tacrolimus or cycrosporine by affecting their absorption or metabolism.
- Ozempic's side effects of nausea, vomiting, and decreased appetite could impact a patient's ability to take other essential medications consistently.
Mechanism of Action
- The drug works by mimicking GLP-1 (glucagon-like peptide-1), which slows gastric emptying and increases insulin secretion while reducing glucagon release, helping control blood sugar and potentially supporting weight management.
- However, these effects on the digestive system could alter the absorption patterns of anti-rejection medications, making careful monitoring essential for transplant patients.
Recent Evidence
- A recent study published in 2023 1 discussed the benefits of SGLT2 inhibitors and GLP-1 receptor agonists, such as semaglutide, in reducing the risk of kidney disease progression and cardiovascular events in patients with type 2 diabetes and chronic kidney disease.
- While the study did not specifically focus on kidney transplant patients, its findings suggest that semaglutide may have beneficial effects on kidney function and cardiovascular risk in patients with kidney disease.
From the FDA Drug Label
Acute Kidney Injury: Monitor renal function in patients with renal impairment reporting severe adverse gastrointestinal reactions (5. 6).
The use of Ozempic in kidney transplant patients is not directly addressed in the drug label. No conclusion can be drawn regarding the safety or efficacy of Ozempic in this population. 2
From the Research
Ozempic and Kidney Transplant Patients
- Ozempic (semaglutide) is a glucagon-like peptide-1 receptor agonist that has been shown to be effective in improving glycemic control and reducing the progression of diabetes kidney disease (DKD) 3.
- The use of Ozempic in patients with advanced-stage chronic kidney disease (CKD) has been approved by the European Medicines Agency, with a minimal estimated glomerular filtration rate (eGFR) of 15 mL/min/1.73 m2 3.
- A case series of patients with advanced DKD in maintenance incremental hemodialysis found that subcutaneous semaglutide treatment was effective in improving glycemic control, lowering HbA1c, albuminuria, weight, and blood pressure control, and preserving residual kidney function (RKF) during a 6-month follow-up 3.
- The management of kidney transplant recipients involves measuring glomerular filtration rate and albuminuria, with estimating equations and albumin-creatinine ratio being used with caution 4.
- A study on metformin use in kidney transplant recipients found that metformin was associated with lower adjusted hazards for living donor and deceased donor allograft survival at 3 years posttransplant, and with lower mortality 5.
- Another study on metformin use in the first year after kidney transplant found that metformin-based regimens were associated with significantly lower adjusted all-cause, malignancy-related, and infection-related mortality, and nonsignificant trends toward lower cardiovascular mortality, graft failure, and acute rejection 6.
- However, there is limited research on the specific use of Ozempic in kidney transplant patients, and further studies are needed to determine its safety and efficacy in this population.
- The available evidence suggests that GLP-1 receptor agonists like Ozempic may be beneficial for patients with DKD, but their use in kidney transplant patients requires careful consideration and monitoring 3, 4, 5, 6.