GLP-1 Receptor Agonist Outcomes, Safety, and Body Mass Index Change in a National Cohort of Patients on Dialysis

Babak J Orandi; Yusi Chen; Yiting Li; David Charytan; Krista L Lentine; Brian P Lee; Nicole Ali; Mario P DeMarco; Michael A Weintraub; Sunjae Bae; Bonnie E Lonze; Christine J Ren-Fielding; Holly Lofton; Akash Gujral; Dorry L Segev; Mara McAdams-DeMarco

doi:10.2215/CJN.0000000750

GLP-1 Receptor Agonist Outcomes, Safety, and Body Mass Index Change in a National Cohort of Patients on Dialysis

Clin J Am Soc Nephrol. 2025 Jun 17;20(8):1100-1110. doi: 10.2215/CJN.0000000750.

Authors

Babak J Orandi^{1

2}, Yusi Chen¹, Yiting Li¹, David Charytan², Krista L Lentine³, Brian P Lee^{4

5}, Nicole Ali², Mario P DeMarco⁶, Michael A Weintraub², Sunjae Bae¹, Bonnie E Lonze¹, Christine J Ren-Fielding¹, Holly Lofton², Akash Gujral¹, Dorry L Segev^{1

4}, Mara McAdams-DeMarco^{1

4}

Affiliations

¹ Department of Surgery, New York University, New York, New York.
² Department of Medicine, New York University, New York, New York.
³ Department of Medicine, Saint Louis University, St. Louis, Missouri.
⁴ Department of Population Health, New York University, New York, New York.
⁵ Department of Medicine, University of Southern California, Los Angeles, California.
⁶ Department of Family Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

PMID: 40526425
PMCID: PMC12342107 (available on 2026-08-01)
DOI: 10.2215/CJN.0000000750

Abstract

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 kg/m²; −4.03 versus −1.47 kg; P < 0.001 for both). The mortality incidence rate was lower among GLP-1 RA users (219.0 versus 279.5 patients/1000 person-years; P < 0.001). GLP-1 RA use was associated with a 23% lower risk of mortality (adjusted hazard ratio [aHR], 0.77; 95% confidence interval [CI], 0.70 to 0.85; P < 0.001); results were consistent among initiates with BMI ≥30 kg/m². GLP-1 RA use was associated with a 66% higher chance of waitlisting (aHR, 1.66; 95% CI, 1.28 to 2.13; P < 0.001). There was an increased association with diabetic retinopathy (aHR, 1.32; 95% CI, 1.12 to 1.56; P = 0.001), but not with any other safety outcomes. Inferences were consistent across multiple sensitivity analyses.

Conclusions: GLP-1 RA use in patients with type 2 diabetes on dialysis was associated with weight loss, reduced mortality risk, and increased likelihood of kidney transplant waitlisting. These real-world data are the strongest evidence to date supporting GLP-1 RA use in this population.

Keywords: ESKD.

Abstract

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