From the Guidelines
Ozempic (semaglutide) is beneficial for patients with diabetic kidney disease (DKD) and should be considered as a treatment option to reduce the risk of kidney disease progression and cardiovascular events. The recommended starting dose is 0.25 mg once weekly by subcutaneous injection for 4 weeks, then increasing to 0.5 mg weekly, with potential further increases to 1 mg or 2 mg weekly if needed for glycemic control 1. For DKD patients, no dose adjustment is required for mild to moderate kidney impairment, but caution is advised in severe kidney impairment as experience is limited. Ozempic works through multiple mechanisms that benefit DKD patients: it improves glycemic control, promotes weight loss, reduces blood pressure, and has direct kidney-protective effects by reducing albuminuria and slowing GFR decline 1.
Some key points to consider when using Ozempic in DKD patients include:
- Monitoring kidney function regularly to assess the effectiveness of treatment and potential kidney-related side effects 1
- Being aware of potential interactions with insulin and sulfonylureas, which may require dose adjustments to prevent hypoglycemia 1
- Common side effects such as nausea, vomiting, and diarrhea, which typically improve over time 1
- The potential benefits of Ozempic in reducing kidney disease progression and cardiovascular events, as demonstrated in clinical trials such as the FLOW trial 1
Overall, Ozempic is a valuable treatment option for patients with DKD, and its use should be considered in the context of individual patient needs and medical history.
From the Research
Ozempic and Diabetic Kidney Disease (DKD)
- Ozempic (semaglutide) is a glucagon-like peptide-1 receptor agonist that has shown promise in managing type 2 diabetes mellitus and slowing the progression of DKD 2, 3.
- The European Medicines Agency has approved the use of semaglutide up to a minimal eGFR of 15 mL/min/1.73 m2, making it a potential treatment option for patients with advanced-stage CKD 2.
- Studies have reported that semaglutide can improve glycemic control, reduce albuminuria, and promote weight loss in patients with DKD 2, 3, 4.
- However, the impact of semaglutide on eGFR is variable, and there is a risk of acute kidney injury (AKI) associated with its use, highlighting the need for careful monitoring and a personalized approach 3, 4.
Renal Outcomes and Semaglutide
- A systematic review of six eligible studies found that semaglutide consistently reduced albuminuria in patients with DKD, particularly those with macroalbuminuria 3.
- The review also reported that semaglutide improved glycemic control and promoted weight loss, with generally manageable gastrointestinal side effects 3.
- Another study found that semaglutide reduced the risk of kidney failure and cardiovascular events in patients with type 2 diabetes and chronic kidney disease, regardless of concomitant SGLT2 inhibitor use 4.
Treatment and Management of DKD
- Screening for early DKD is best done with annual spot urine albumin/creatinine ratio testing, and diagnosis is confirmed by repeated elevation in urinary albumin excretion 5.
- Treatment of DKD includes management of hyperglycemia, hypertension, hyperlipidemia, and cessation of tobacco use, as well as the use of antihyperglycemic medications such as sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, and dipeptidyl-peptidase-4 inhibitors 5.
- Blood pressure should be monitored at every clinical visit and maintained at less than 140/90 mm Hg to prevent microvascular changes, and statin therapy should be considered for all patients with DKD 5.