From the Guidelines
Tirzepatide (Mounjaro) should be used with caution in patients with pre-existing kidney disease, particularly those with severe kidney impairment (eGFR <30 mL/min/1.73m²) or end-stage renal disease, as it may cause renal adverse effects. When considering the use of Mounjaro in patients with kidney disease, it is essential to assess the patient's renal function and adjust the treatment plan accordingly.
- For patients with mild to moderate kidney impairment (eGFR ≥30 mL/min/1.73m²), no dose adjustment is necessary, but closer monitoring for adverse effects is recommended 1.
- In severe kidney impairment (eGFR <30 mL/min/1.73m²) or end-stage renal disease, limited clinical experience exists, so caution is warranted, and it is not recommended for patients with CrCl <30 or eGFR <45 1. Key considerations for patients with pre-existing kidney disease include:
- Monitoring renal function regularly, as Mounjaro may cause gastrointestinal side effects like nausea, vomiting, and diarrhea that could lead to dehydration and worsen kidney function.
- Ensuring patients maintain adequate hydration to prevent dehydration-related kidney damage.
- Being aware of the potential renoprotective effects of Mounjaro, which may reduce hyperfiltration and albuminuria due to improved glycemic control, weight reduction, and direct effects on renal hemodynamics through its GLP-1 and GIP receptor agonism.
- Using the medication cautiously in patients with a history of acute kidney injury or those taking medications that affect renal function, such as diuretics, ACE inhibitors, or ARBs. It is crucial to weigh the potential benefits of Mounjaro against the risks of renal adverse effects and to closely monitor patients with pre-existing kidney disease to minimize the risk of kidney damage.
From the FDA Drug Label
- 6 Renal Impairment No dosage adjustment of MOUNJARO is recommended for patients with renal impairment. In subjects with renal impairment including end-stage renal disease (ESRD), no change in tirzepatide pharmacokinetics (PK) was observed [see Clinical Pharmacology (12. 3)]. Monitor renal function when initiating or escalating doses of MOUNJARO in patients with renal impairment reporting severe adverse gastrointestinal reactions [see Warnings and Precautions (5.5)].
Renal Considerations:
- No dosage adjustment of Mounjaro is recommended for patients with renal impairment.
- Patients with renal impairment should be monitored for renal function when initiating or escalating doses of Mounjaro, especially if they report severe adverse gastrointestinal reactions 2.
- Key Points:
- No change in tirzepatide pharmacokinetics was observed in subjects with renal impairment, including end-stage renal disease (ESRD).
- Monitor renal function in patients with renal impairment.
From the Research
Renal Considerations for Mounjaro (Tirzepatide)
Overview of Renal Effects
- Mounjaro (tirzepatide) has been studied for its renal effects in patients with type 2 diabetes and obesity, with and without pre-existing kidney disease 3, 4, 5, 6, 7.
- The evidence suggests that tirzepatide may have a positive impact on renal outcomes, including a reduction in urine albumin-to-creatinine ratio (UACR) and a slowing of the decline in estimated glomerular filtration rate (eGFR) 3, 6, 7.
Renal Safety Profile
- Tirzepatide has been found to have a reassuring renal safety profile, with no increased risk of adverse renal events, urinary tract infection, nephrolithiasis, acute kidney injury, or renal cancer compared to placebo, insulin, or glucagon-like peptide-1 receptor agonists 3.
- The renal safety profile of tirzepatide is supported by multiple studies, including a systematic review and meta-analysis of randomized controlled trials 3 and a post-hoc analysis of the SURPASS-4 trial 7.
Clinical Implications
- The use of tirzepatide in patients with pre-existing kidney disease may be beneficial for improving glycemic control, reducing blood pressure, and slowing the progression of kidney disease 5, 6, 7.
- However, larger and longer-term studies are needed to fully understand the renal benefits and safety of tirzepatide in patients with kidney disease 3, 4, 6.
- Clinicians should carefully consider the potential benefits and risks of tirzepatide in patients with kidney disease and monitor renal function closely during treatment 5, 7.