Can Mounjaro (tirzepatide) be used in patients undergoing dialysis (hemodialysis)?

Tirzepatide (Mounjaro) Use in Dialysis Patients

Tirzepatide (Mounjaro) can be safely used in patients undergoing dialysis without dose adjustment, as pharmacokinetic studies show no clinically relevant effects of renal impairment on tirzepatide metabolism.

Pharmacokinetics in Renal Impairment

Tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, has been specifically studied in patients with various degrees of renal impairment:

• A dedicated pharmacokinetic study demonstrated that tirzepatide exposure was similar across all renal impairment groups, including end-stage renal disease (ESRD) requiring dialysis 1
• No significant relationship was found between tirzepatide exposure and estimated glomerular filtration rate (eGFR) 1
• Only a modest 25-29% increase in drug exposure was observed in moderate renal impairment, which is not considered clinically significant 1

Clinical Evidence in Dialysis Patients

Recent clinical evidence supports the use of tirzepatide in dialysis patients:

• A 2024 study specifically evaluated tirzepatide in Type 2 diabetes patients undergoing hemodialysis and found it effectively provided good glycemic control 2
• The study demonstrated significant reductions in glycated albumin, dry weight, and body mass index without serious adverse effects 2
• Fat mass was reduced without decreasing skeletal muscle mass, suggesting tirzepatide may help manage weight without increasing frailty risk in this vulnerable population 2

Safety Considerations

While tirzepatide appears safe in dialysis patients, several precautions should be observed:

1. Acute Kidney Injury Risk: Tirzepatide can cause gastrointestinal adverse reactions (nausea, vomiting, diarrhea) that may lead to dehydration. In patients with existing renal impairment, this could potentially worsen kidney function 3

2. Monitoring Requirements:

   • Monitor for signs of dehydration
   • Assess for gastrointestinal symptoms that could lead to fluid imbalances
   • Consider temporarily holding the medication if severe gastrointestinal symptoms develop

3. Hypoglycemia Risk: When used with insulin or insulin secretagogues, there is an increased risk of hypoglycemia. Consider reducing doses of these medications when initiating tirzepatide 3

Renal Benefits

Tirzepatide may offer renal benefits beyond glycemic control:

• Meta-analysis data shows tirzepatide reduces urine albumin-to-creatinine ratio (UACR) without detrimental effects on eGFR 4
• At 10mg and 15mg doses, tirzepatide demonstrated superior UACR reductions compared to placebo (-26.95% and -18.03%, respectively) 4
• No increased risks of adverse renal events, urinary tract infections, nephrolithiasis, or acute kidney injury were observed compared to placebo, insulin, or other GLP-1 receptor agonists 4

Practical Administration in Dialysis Patients

• No dose adjustment is required for patients on dialysis 1
• Start with the lowest dose (2.5mg weekly) and titrate gradually to minimize gastrointestinal side effects
• Administer on a consistent schedule relative to dialysis sessions
• Monitor for nausea, which was the most commonly reported side effect in dialysis patients 2

Conclusion

Unlike some medications that require significant dose adjustments or are contraindicated in dialysis patients, tirzepatide appears to maintain its safety profile and efficacy in this population. The 2024 study specifically in hemodialysis patients provides the most recent and direct evidence supporting its use in this setting 2.