Semaglutide, a glucagon-like peptide-1 receptor agonist, has been shown to have both protective and potentially adverse effects on kidney function.
Protective effects
- Chronic kidney disease (CKD): Semaglutide has been associated with a reduced risk of clinically important kidney outcomes and death from cardiovascular causes in patients with type 2 diabetes and CKD
- Albuminuria and kidney function: In patients with type 2 diabetes, semaglutide has been shown to lower albuminuria and slow the decline in estimated glomerular filtration rate (eGFR)
- Overweight or obesity: In adults with overweight or obesity, semaglutide improved urine albumin-to-creatinine ratio (UACR) and did not affect eGFR decline in participants with normal kidney function
Potential adverse effects
- Acute kidney injury (AKI): Semaglutide has been associated with an increased risk of acute renal failure and worsening of chronic renal failure. It is recommended to monitor renal function when initiating or increasing the dose of semaglutide in patients with severe gastrointestinal reactions
- Kidney perfusion: Semaglutide has been shown to substantially reduce kidney perfusion without affecting oxygenation
Dosage adjustment in renal impairment
- Semaglutide can be used in patients with creatinine clearance (CrCl) 0–90 mL/min without dose adjustment
- It is also acceptable for use in patients on any modality of renal replacement therapy without dose adjustment
In conclusion, semaglutide has demonstrated kidney-protective effects in certain patient populations, but it also carries a risk of acute renal failure and worsening of chronic renal failure. Therefore, careful monitoring of renal function is recommended when initiating or increasing the dose of semaglutide, particularly in patients with severe gastrointestinal reactions.