From the Research
Tirzepatide and Ozempic (semaglutide) are not typically associated with causing metabolic acidosis, and the most recent evidence suggests that tirzepatide has a positive impact on renal function without increasing the risk of adverse renal events 1. These medications are GLP-1 receptor agonists used for treating type 2 diabetes and obesity, and they work by increasing insulin secretion, decreasing glucagon secretion, slowing gastric emptying, and reducing appetite. The most common side effects include gastrointestinal symptoms like nausea, vomiting, and diarrhea. While severe gastrointestinal symptoms could potentially lead to dehydration and electrolyte imbalances that might contribute to acidosis in extreme cases, this is not a recognized direct effect of these medications. However, patients with diabetes, especially those with poor glycemic control or concurrent illness, may develop diabetic ketoacidosis (DKA) or lactic acidosis due to their underlying condition or other medications they may be taking (like metformin). It's essential for patients taking these medications to stay well-hydrated, monitor their blood glucose regularly, and seek medical attention if they experience persistent vomiting, unusual fatigue, difficulty breathing, or confusion, which could indicate an acid-base disturbance requiring immediate medical attention. A recent systematic review and meta-analysis found that tirzepatide positively impacts urine albumin-to-creatinine ratio (UACR) without detrimental effects on estimated glomerular filtration rate (eGFR) in subjects with type 2 diabetes and obesity without type 2 diabetes, with a reassuring renal safety profile 1. Additionally, a study comparing tirzepatide to semaglutide found that tirzepatide was noninferior and superior to semaglutide in reducing glycated hemoglobin levels and body weight, with a similar safety profile 2. Overall, the current evidence suggests that tirzepatide and Ozempic are not associated with an increased risk of metabolic acidosis, and tirzepatide may have beneficial effects on renal function. Key points to consider:
- Tirzepatide and Ozempic are not typically associated with causing metabolic acidosis
- Tirzepatide has a positive impact on renal function without increasing the risk of adverse renal events
- Patients with diabetes should stay well-hydrated, monitor their blood glucose regularly, and seek medical attention if they experience symptoms of an acid-base disturbance
- Tirzepatide may have beneficial effects on renal function, including reducing UACR and improving eGFR.