Can a patient on chronic hemodialysis or peritoneal dialysis be prescribed Mounjaro (tirzepatide)?

Can a Dialysis Patient Have Mounjaro (Tirzepatide)?

Yes, dialysis patients can receive Mounjaro (tirzepatide) without dose adjustment, as renal impairment—including end-stage renal disease requiring dialysis—does not significantly alter tirzepatide pharmacokinetics or safety.

Pharmacokinetic Evidence Supporting Use in Dialysis

• A dedicated renal impairment study demonstrated that tirzepatide exposure (AUC and Cmax) was similar across all renal function categories, including patients with end-stage renal disease on dialysis, compared to those with normal renal function 1
• The only exception was a modest 25-29% increase in AUC observed in moderate renal impairment, but this was not clinically significant and did not occur in dialysis patients 1
• Linear regression analysis showed no significant relationship between tirzepatide exposure and estimated glomerular filtration rate (eGFR), confirming that kidney function does not meaningfully impact drug levels 1
• No dose adjustment is required for patients with any degree of renal impairment, including those on hemodialysis or peritoneal dialysis 1

Clinical Experience in Dialysis Patients

• A retrospective study of 9 type 2 diabetes patients on hemodialysis receiving tirzepatide 2.5-7.5 mg weekly demonstrated effective glycemic control with significant reductions in glycated albumin (22.7% to 18.3%, p=0.028) 2
• These hemodialysis patients experienced beneficial reductions in dry weight (-1.0 kg) and body mass index (-0.6 kg/m²) primarily through fat mass loss, without significant skeletal muscle mass reduction 2
• No serious adverse events beyond nausea were reported during treatment in dialysis patients 2

Safety Profile in Renal Impairment

• Adverse events in the renal impairment study were few across all groups, with the majority being mild gastrointestinal symptoms typical of GLP-1 receptor agonists 1
• Meta-analysis of 15 randomized controlled trials (n=14,471) showed tirzepatide does not increase risks of adverse renal events, acute kidney injury, urinary tract infection, nephrolithiasis, or renal cancer 3
• Changes from baseline in eGFR were comparable across all tirzepatide doses versus insulin, indicating no detrimental effects on residual kidney function 3

Renal Benefits Beyond Dialysis Patients

• For patients with chronic kidney disease not yet on dialysis, tirzepatide significantly reduces urine albumin-to-creatinine ratio (UACR) by 26.95% with the 10 mg dose and 18.03% with the 15 mg dose compared to placebo 3
• The UACR reduction was particularly pronounced in patients with type 2 diabetes (-33.25%) compared to those with obesity alone (-7.93%) 3

Important Caveats and Monitoring

• While one case report described rhabdomyolysis potentially associated with tirzepatide in a patient without comorbidities, this remains an extremely rare event requiring awareness but not routine monitoring 4
• The gastrointestinal side effects (nausea, vomiting, diarrhea) characteristic of GLP-1 receptor agonists may theoretically affect fluid balance in dialysis patients, warranting clinical monitoring of dry weight and volume status 2
• Tirzepatide's weight loss effects in dialysis patients appear to preferentially target fat mass rather than muscle mass, which is favorable given the high prevalence of protein-energy wasting in this population 2

Practical Prescribing Approach

• Initiate tirzepatide at standard starting doses (2.5 mg weekly) and titrate according to standard protocols regardless of dialysis status 1
• Monitor glycemic control using glycated albumin rather than HbA1c in dialysis patients, as HbA1c may be unreliable due to altered red blood cell turnover 2
• Assess dry weight and body composition changes to ensure weight loss is primarily from fat mass reduction 2
• No special timing relative to dialysis sessions is required, as tirzepatide is administered subcutaneously once weekly and is not removed by dialysis 1