From the Guidelines
Wegovy (semaglutide) is not likely to cause impaired renal function, and in fact, it has been shown to reduce the risk of new or worsening nephropathy by 36% compared to placebo 1. The medication is primarily cleared through the kidneys, so patients with kidney impairment may need dose adjustments or closer monitoring. Some patients taking Wegovy may experience dehydration due to side effects like nausea, vomiting, or diarrhea, which could potentially stress the kidneys. There have been rare reports of acute kidney injury in patients taking GLP-1 receptor agonists like Wegovy, particularly when combined with other medications that affect kidney function or in patients who become severely dehydrated. If you have existing kidney disease, your doctor should monitor your kidney function regularly while taking Wegovy. The medication should be used cautiously in patients with severe kidney impairment, and dosing adjustments may be necessary. Anyone experiencing symptoms like decreased urination, swelling in legs or feet, or unusual fatigue while taking Wegovy should contact their healthcare provider immediately, as these could indicate kidney problems. Key benefits of semaglutide include reducing the risk of major adverse cardiovascular events (MACE) in patients with type 2 diabetes, and slowing eGFR decline, as evidenced by secondary outcomes assessed in cardiovascular outcomes trials 1. It's also important to note that GLP-1 receptor agonists, including semaglutide, have been shown to reduce albuminuria and slow eGFR decline, and are preferred agents for patients with type 2 diabetes and chronic kidney disease 1. Overall, the benefits of semaglutide in reducing the risk of kidney disease and cardiovascular events outweigh the potential risks, and it can be a valuable treatment option for patients with type 2 diabetes and normal kidney function, as well as those with existing kidney disease, under close monitoring and with appropriate dose adjustments.
From the FDA Drug Label
Patients with Renal impairment - Renal impairment does not impact the pharmacokinetics of semaglutide in a clinically relevant manner. This was shown in a study with a single dose of 0. 5 mg semaglutide in patients with different degrees of renal impairment (mild, moderate, severe, ESRD) compared with subjects with normal renal function.
Wegovy (semaglutide) does not cause impaired renal function. The pharmacokinetics of semaglutide are not affected by renal impairment in a clinically relevant manner, as shown in studies with patients with different degrees of renal impairment 2.
From the Research
Impaired Renal Function and Wegovy (Semaglutide)
- The relationship between semaglutide and impaired renal function is complex, with some studies suggesting potential benefits and others indicating possible risks 3, 4, 5, 6, 7.
- A study published in the Clinical Kidney Journal found that semaglutide had nephroprotective effects in patients with type 2 diabetes and chronic kidney disease, with a significant decrease in albuminuria and stable estimated glomerular filtration rate (eGFR) 3.
- However, a case report published in Kidney Medicine described two patients with chronic kidney disease who experienced rapid worsening of kidney function and increased proteinuria after starting semaglutide, highlighting the need for caution in patients with moderate to severe chronic kidney disease 4.
- A retrospective cohort study published in Endocrine Practice found that semaglutide was generally well-tolerated in patients with advanced chronic kidney disease, with improvements in glycemic control and weight loss, but also reported gastrointestinal side effects as the primary reason for discontinuation 5.
- A post-hoc analysis of the SUSTAIN 1-7 trials published in The Lancet Diabetes & Endocrinology found that semaglutide was associated with initial reductions in eGFR that plateaued, and marked reductions in urinary albumin-to-creatinine ratio (UACR), with no increase in the risk of kidney adverse events compared to active comparators 6.
- A randomized double-blind placebo-controlled clinical trial published in Nature Medicine found that semaglutide reduced albuminuria in patients with overweight or obesity and chronic kidney disease without diabetes, but also reported gastrointestinal adverse events as a common side effect 7.
Key Findings
- Semaglutide may have nephroprotective effects in patients with type 2 diabetes and chronic kidney disease 3.
- Caution is needed when using semaglutide in patients with moderate to severe chronic kidney disease due to limited kidney reserve 4.
- Semaglutide can improve glycemic control and weight loss in patients with advanced chronic kidney disease, but may also cause gastrointestinal side effects 5.
- Semaglutide is associated with initial reductions in eGFR that plateau, and marked reductions in UACR, with no increase in the risk of kidney adverse events compared to active comparators 6.
- Semaglutide can reduce albuminuria in patients with overweight or obesity and chronic kidney disease without diabetes, but may also cause gastrointestinal adverse events 7.