From the Guidelines
Wegovy (semaglutide) can be used with caution in patients with a GFR of 58 ml/min/1.73m², as no dose adjustment is typically required at this GFR level, according to the most recent evidence from 1 and 1.
Key Considerations
- The medication is primarily eliminated through protein catabolism and is not expected to be significantly affected by reduced kidney function, as stated in 1.
- Patients with kidney impairment should be monitored more closely for potential side effects, particularly gastrointestinal symptoms and dehydration which could potentially affect kidney function.
- The standard Wegovy dosing schedule starts at 0.25 mg once weekly for the first month, then increases gradually (0.5 mg, 1 mg, 1.7 mg) at monthly intervals until reaching the maintenance dose of 2.4 mg weekly.
Monitoring and Precautions
- It's essential to maintain adequate hydration while taking this medication and to have regular kidney function monitoring, as recommended in 1.
- Any worsening of kidney function should prompt reevaluation of the medication's risks and benefits.
Evidence Summary
- The evidence from 1 and 1 suggests that semaglutide can be used safely in patients with mild kidney impairment, with no dose adjustment required for a GFR of 58 ml/min/1.73m².
- However, it's crucial to prioritize caution and closely monitor patients for potential side effects, as kidney function may impact the medication's efficacy and safety.
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.
- Renal impairment does not have a clinically meaningful effect on the pharmacokinetics of semaglutide.
- A GFR of 58 indicates mild renal impairment.
- Based on the information provided, semaglutide can be used in patients with a GFR of 58, as renal impairment does not impact its pharmacokinetics in a clinically relevant manner 2.
From the Research
Semaglutide Use in Patients with Reduced Kidney Function
- The use of semaglutide in patients with reduced kidney function, such as those with an estimated glomerular filtration rate (eGFR) of 58, has been studied in several trials 3, 4, 5, 6.
- A post-hoc analysis of the SUSTAIN 1-7 trials found that semaglutide was associated with initial reductions in eGFR that plateaued, and marked reductions in urinary albumin-to-creatinine ratio (UACR) 3.
- A real-world study of patients with type 2 diabetes and chronic kidney disease found that semaglutide improved glycemic control and decreased weight, with no significant changes in eGFR 4.
- A retrospective cohort study of patients with advanced chronic kidney disease (CKD) found that semaglutide was tolerated by most individuals, despite associated gastrointestinal side effects, and led to improvements in glycemic control and weight loss 5.
- A post-hoc pooled analysis of the SUSTAIN 6 and PIONEER 6 trials found that semaglutide consistently reduced major adverse cardiovascular events (MACE) risk versus placebo across all eGFR and UACR subgroups, including those with reduced kidney function 6.
Safety and Efficacy of Semaglutide in Patients with Reduced Kidney Function
- The safety and efficacy of semaglutide in patients with reduced kidney function have been evaluated in several studies 3, 4, 5, 6.
- Overall, the studies suggest that semaglutide is safe and effective in patients with reduced kidney function, including those with an eGFR of 58.
- However, patients with reduced kidney function may be at increased risk of adverse events, such as gastrointestinal side effects and hypoglycemia 5, 7.
- Close monitoring and supportive care are recommended in patients with reduced kidney function who are treated with semaglutide 7.
Key Findings
- Semaglutide is associated with initial reductions in eGFR that plateau, and marked reductions in UACR 3.
- Semaglutide improves glycemic control and decreases weight in patients with type 2 diabetes and chronic kidney disease 4.
- Semaglutide is tolerated by most individuals with advanced CKD, despite associated gastrointestinal side effects, and leads to improvements in glycemic control and weight loss 5.
- Semaglutide consistently reduces MACE risk versus placebo across all eGFR and UACR subgroups, including those with reduced kidney function 6.