GLP-1 receptor agonist outcomes, safety, and body mass index change in a national cohort of patients on dialysis
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Key Points GLP-1 receptor agonists (GLP-1 RAs) in diabetes and dialysis are associated with 23% lower mortality and 66% higher chance of transplant waitlisting. GLP-1 RAs are not associated with increased risk of acute pancreatitis, biliary complications, or medullary thyroid cancer. GLP-1 RAs are associated with a 32% increased risk of diabetic retinopathy in patients with diabetes on dialysis. Background Of the 808,000 US patients on dialysis, 60% have diabetes and are eligible for glucagon-like peptide-1 receptor agonists (GLP-1 RAs). Safety and outcomes in this population are unknown. We sought to examine GLP-1 RA real-world safety, efficacy, and weight loss in people with diabetes on dialysis. Methods In this observational national cohort study (2013–2021), we identified adults with type 2 diabetes on dialysis. The exposure of interest was GLP-1 RA use. Body mass index (BMI) change after dialysis initiation was quantified among patients with two measurements ( N =6474). Extended Cox models with inverse probability of treatment weights (censoring for kidney transplant waitlisting) were used to quantify all-cause mortality associated with GLP-1 RAs. Specific safety outcomes (acute pancreatitis, biliary complications, medullary thyroid cancer, and diabetic retinopathy) were assessed. Results The study included 151,649 patients on incident dialysis with type 2 diabetes. Mean BMI and weight change among GLP-1 RA users were greater than those among nonusers (−1.47 versus −0.61…
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In a national cohort study of 151,649 individuals with type 2 diabetes initiating dialysis between 2013 and 2021, GLP-1-based therapy was associated with a 23% lower mortality and 66% higher chance of transplant waitlisting.
“In a national cohort study of 151,649 individuals with type 2 diabetes initiating dialysis between 2013 and 2021, GLP-1-based therapy was associated with a 23% lower mortality and 66% higher chance of transplant waitlisting (157).”
From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [157]
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References 73 · Cited by 38
- Authors
- Orandi, B. J., Chen, Y., Li, Y., Charyton, D., Lentine, K. L., Lee, B. P., Ali, N., DeMarco, M. P., Weintraub, M. A., Bae, S., Lonze, B. E., Ren-Fielding, C. J., Lofton, H., Gujral, A., Segev, D. L., & McAdams-DeMarco, M.
- Affiliations
- New York University (US)
- Department of Medicine, New York University, New York, New York
- Saint Louis University (US)
- University of Southern California (US)
- University of Pennsylvania (US)
- Department of Surgery, New York University, New York, New York
- ORCID
- Venue
- Clinical Journal of the American Society of Nephrology
- Published
- 2025-06-17
- Volume
- 20
- Issue
- 8
- Pages
- 1100-1110
- ISSN
- 1555-9041 (ISSN-L)
- 1555-905X
- OpenAlex
- W4411366578
- Cited by
- 38
- References
- 73
- Citations by year
- 2026: 27 · 2025: 11
- FWCI
- 25.81
- Type
- journal article
- Language
- en
- Open access
- Locations
- Clinical Journal of the American Society of Nephrology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion)
- Funders
- National Institutes of Health (K01DK132490, K24AI144954)
- Mid-America Transplant/Jane A. Beckman endowed chair in transplantation
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Keywords
- GLP-1 receptor agonists, dialysis, type 2 diabetes, all-cause mortality, body mass index change, weight loss, acute pancreatitis, biliary complications, medullary thyroid carcinoma, diabetic retinopathy, drug safety, real-world outcomes, obesity, inverse probability of treatment weighting, propensity score matching
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