GLP-1 Receptor Agonists and Kidney Disease: What Patients Need to Know

How common is kidney disease in type 2 diabetes?

The CDC estimates that 37 million US adults, about 14%, have chronic kidney disease, and that roughly 41% of adults with type 2 diabetes are estimated to have it [6]. An estimated 87% of US adults aged 20 or older with CKD did not know they had it [6].

What do GLP-1 drugs do for the kidneys?

GLP-1 receptor agonists are now grouped with the other drugs used to protect kidneys in diabetes. A 2024 review of diabetic kidney disease lists nephroprotective agents as ACE inhibitors, ARBs, SGLT2 inhibitors and GLP-1 receptor agonists [8].

The dedicated kidney trial is FLOW: 3,533 adults with type 2 diabetes and chronic kidney disease were randomized to Ozempic 1 mg weekly or placebo and followed for a median of 3.4 years before the trial was stopped early at an interim analysis. Kidney failure, a 50% or greater eGFR decline, or kidney or cardiovascular death occurred in 18.7% on semaglutide versus 23.2% on placebo (HR 0.76, 95% CI 0.66 to 0.88). All-cause death was 12.8% versus 15.8% (HR 0.80). Benefit was not evident in the few patients on an SGLT2 inhibitor at baseline [15].

Class-level data come from trials built around heart outcomes. A 2019 meta-analysis pooled seven cardiovascular outcome trials of GLP-1 receptor agonists in type 2 diabetes, with 56,004 participants, and reported that treatment reduced a broad composite kidney outcome that included new-onset macroalbuminuria and decline in estimated glomerular filtration rate [7]. Because these were cardiovascular outcome trials, major cardiovascular events were the main endpoint [7]. A 2025 review states that in chronic kidney disease, semaglutide has been associated with a reduction in renal events and slower disease progression [9].

Which GLP-1 product is labeled for kidney outcomes?

Ozempic. Its label covers kidney outcomes in adults with type 2 diabetes and chronic kidney disease, alongside its type 2 diabetes and cardiovascular indications [1]. Semaglutide is also sold as Wegovy, whose labeled uses are weight reduction, cardiovascular risk reduction and MASH, and as oral semaglutide, labeled for type 2 diabetes and cardiovascular risk reduction [2][10].

The rest of the class does not have a kidney entry on its label. Trulicity is labeled for type 2 diabetes and for cardiovascular risk reduction in adults with established cardiovascular disease or multiple risk factors [4]. Victoza is labeled for type 2 diabetes and cardiovascular risk reduction [11]. Mounjaro is labeled for type 2 diabetes; Zepbound for weight reduction and sleep apnea [5][12]. Foundayo, the oral orforglipron tablet, is labeled for weight reduction and maintenance only [3]. Tirzepatide is a dual GIP and GLP-1 receptor agonist, not a pure GLP-1 agonist, so the Ozempic kidney indication is a semaglutide label statement [1][5].

What do the labels say about kidney harm?

The Wegovy label lists acute kidney injury due to volume depletion and says to monitor renal function in patients reporting adverse reactions that could lead to volume depletion [2]. In its trials, acute kidney injury occurred in 0.4 versus 0.2 cases per 100 patient-years (7 versus 4 adults), more often in patients with prior renal impairment and during dose titration, often after gastrointestinal fluid loss [2].

The Foundayo label is more detailed. It describes reports of acute kidney injury, in some cases requiring hemodialysis, in patients treated with GLP-1 receptor agonists or with Foundayo, with the majority of events occurring in patients who had gastrointestinal reactions leading to dehydration such as nausea, vomiting or diarrhea. It says to monitor renal function in patients reporting reactions that could lead to volume depletion, especially during dosage initiation and escalation [3].

In the Foundayo weight-management trials, acute kidney injury was reported in 0.2% of treated patients versus 0.05% on placebo, and hypotension in 2% versus 0.5%; among treated patients, hypotension was 4% in those also taking blood-pressure drugs versus 1% in those not taking them [3].

Gastrointestinal reactions are common: with Wegovy 2.4 mg, nausea occurred in 44% versus 16% on placebo and vomiting in 24% versus 6% [2]. With Foundayo 17.2 mg, vomiting occurred in 24% versus 4% [3].

The Ozempic and Zepbound labels recommend no dose adjustment for renal impairment [1][5].

Obesity and kidney disease

Obesity is strongly related to the risk of chronic kidney disease, its progression and end-stage renal disease [13]. A 2023 review noted that a long-acting GLP-1 receptor agonist and a GLP-1/GIP co-agonist had been shown to produce weight loss in people without CKD, and that definitive studies in patients with CKD were still awaited at that time [13].