From the Guidelines
Ozempic (semaglutide) has been shown to reduce the risk of new or worsening nephropathy by 36% in patients with type 2 diabetes, making it a beneficial treatment option for patients with impaired renal function (kidney disease) 1.
Key Points to Consider
- The medication works by mimicking GLP-1 (glucagon-like peptide-1), which helps regulate blood sugar, reduces inflammation, decreases blood pressure, and may directly protect kidney cells.
- The standard starting dose is 0.25 mg once weekly by subcutaneous injection for four weeks, then increasing to 0.5 mg weekly, with possible further increases to 1 mg or 2 mg weekly if needed for glycemic control.
- For patients with kidney disease, no dose adjustment is necessary for mild to moderate kidney impairment, though caution is advised in severe kidney disease (eGFR <30 ml/min/1.73m²) 1.
- Common side effects include nausea, vomiting, diarrhea, and abdominal pain, which typically improve over time.
- Patients should maintain adequate hydration while taking Ozempic, especially those with kidney concerns, and should have regular kidney function monitoring during treatment.
Important Considerations for Patients with Kidney Disease
- GLP-1 receptor agonists, such as semaglutide, can be considered for patients with type 2 diabetes and CKD who require another drug added to metformin to attain target A1C or cannot use or tolerate metformin 1.
- SGLT2 inhibitors and GLP-1 RAs should be considered for patients with type 2 diabetes and CKD who require another drug added to metformin to attain target A1C or cannot use or tolerate metformin 1.
- The U.S. Food and Drug Administration (FDA) revised its guidance for the use of metformin in CKD in 2016, recommending use of eGFR instead of serum creatinine to guide treatment and expanding the pool of patients with kidney disease for whom metformin treatment should be considered 1.
From the FDA Drug Label
6 Renal Impairment No dose adjustment of OZEMPIC is recommended for patients with renal impairment. In subjects with renal impairment including end-stage renal disease (ESRD), no clinically relevant change in semaglutide pharmacokinetics (PK) was observed [see Clinical Pharmacology (12.3)].
6 Acute Kidney Injury: Monitor renal function in patients with renal impairment reporting severe adverse gastrointestinal reactions
The effect of Ozempic (semaglutide) on impaired renal function (kidney disease) is that no dose adjustment is recommended for patients with renal impairment. However, it is advised to monitor renal function in patients with renal impairment who report severe adverse gastrointestinal reactions, due to the risk of acute kidney injury. 2 2 2
From the Research
Effect of Ozempic (Semaglutide) on Impaired Renal Function
- Ozempic (semaglutide) has been shown to have beneficial effects on glycemic control, weight loss, and renal outcomes in patients with type 2 diabetes and chronic kidney disease (CKD) 3, 4, 5, 6.
- Studies have demonstrated that semaglutide can be used safely in patients with advanced-stage CKD, with the European Medicines Agency approving its use up to a minimal eGFR of 15 mL/min/1.73 m2 3.
- A multicenter real-world study found that the efficacy of semaglutide in improving glycemic control and weight loss was not notably lower in patients with CKD compared to those without renal failure 5.
- Another study found that semaglutide treatment resulted in significant improvements in glycemic control, weight loss, and reduction in albuminuria in patients with type 2 diabetes and CKD 6.
- However, there have been reports of acute kidney injury associated with semaglutide use, particularly in patients with moderate to severe CKD, highlighting the need for caution and close monitoring of kidney function in these patients 7.
Key Findings
- Semaglutide can improve glycemic control, weight loss, and renal outcomes in patients with type 2 diabetes and CKD 3, 5, 6.
- The medication can be used safely in patients with advanced-stage CKD, but caution is advised in those with moderate to severe CKD due to limited kidney reserve 3, 7.
- Regular monitoring of kidney function and laboratory tests is recommended, particularly in patients experiencing adverse gastrointestinal symptoms 7.