GLP-1 Medications and Kidney Disease: Benefits and Risks

Glucagon-like peptide-1 (GLP-1) receptor agonists are a class of medications initially approved to treat Type 2 diabetes. But they have shown benefits in a wide range of conditions including obesity, obstructive sleep apnea, and metabolic-associated steatohepatitis. 

There are a growing number of FDA-approved GLP-1 medications, including:

How do GLP-1s work?

GLP-1 medications act like glucagon-like peptide-1, a hormone made in the gut. They bind to the same receptors in the body, which allows them to produce similar effects. 

GLP-1s work to treat Type 2 diabetes and obesity by:

• Increasing insulin production 

• Delaying gastric emptying 

• Curbing appetite

GLP-1s also work on other body systems including the kidneys, heart, and blood vessels. They have been shown to:

• Improve blood vessel health

• Lower inflammation

• Reduce the risk of heart attack and stroke in people with Type 2 diabetes 

What are the benefits of taking GLP-1s with kidney disease?

Studies show that GLP-1s can help protect kidney health in people living with Type 2 diabetes and chronic kidney disease. There’s no cure for chronic kidney disease, and the condition tends to get worse over time. GLP-1s can slow down chronic kidney disease. This can help people avoid serious health complications like kidney failure and need for dialysis.

About 40% of people living with Type 2 diabetes will develop chronic kidney disease. For those who haven’t developed it, GLP-1 medications may still offer some kidney health benefits. 

Researchers are currently studying whether these medications can help prevent chronic kidney disease, but we don’t have clear answers yet. 

GLP-1 medications help protect kidney health by:

• Improving blood sugar management: High blood sugar can damage the small blood vessels in the kidneys over time, so better control helps protect kidney function.

• Improving enzyme and hormone levels: GLP-1s help stabilize renin and angiotensin levels, which play a role in kidney function. 

• Lowering blood pressure: GLP-1s can help lower blood pressure, which decreases strain on the kidneys.

• Helping the body remove extra salt: These medications increase sodium levels in the urine, which can support healthier blood pressure levels.

• Decreasing inflammation in the kidneys: GLP-1s may reduce inflammation, which can slow kidney damage over time.

Are any GLP-1s FDA approved for kidney disease?

Ozempic (semaglutide) is the only GLP-1 medication that’s FDA approved to treat chronic kidney disease in people with Type 2 diabetes.

Other GLP-1 medications may be approved to treat chronic kidney disease in the future. 

Are GLP-1s safe for people with kidney disease?

Yes, GLP-1 medications are generally safe for people who have kidney disease related to Type 2 diabetes. Studies suggest that people with Type 2 diabetes with severe kidney disease can use these medications safely. This includes people who’ve had a kidney transplant.

There isn’t much research on how safe or effective GLP-1 medications are for people with kidney disease not related to Type 2 diabetes. We also don’t have strong evidence that these medications can slow kidney damage or prevent complications in these cases.

That said, kidney disease isn’t listed as a contraindication for GLP-1 medications. This means they may still be an option, but your healthcare team will need to consider your individual situation.

If you’re taking GLP-1 medications and have chronic kidney disease, keep in mind that these medications can cause side effects like nausea, vomiting, and diarrhea. These side effects tend to be worse when starting treatment or increasing the dose. These symptoms can lead to dehydration. Dehydration can reduce blood flow to the kidneys and increase the risk of acute kidney injury, which may worsen kidney function.

Does insurance cover GLP-1s for kidney disease?

Ozempic is FDA approved to treat chronic kidney disease in people with Type 2 diabetes. Because of this, commercial insurance and Medicare may cover it if you have both conditions.

Other GLP-1 medications don’t have this specific approval, so they’re unlikely to be covered for kidney disease alone. However, they may still be covered if you have another approved indication, like Type 2 diabetes.

GLP-1 medications aren’t approved to treat other types of kidney disease, so insurance typically won’t cover them for that reason by itself.

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Written by:

Christine Giordano, MD

Christine Giordano, MD, is board-certified in general internal medicine. She received her medical degree from Rutgers New Jersey Medical School and completed residency at Thomas Jefferson University.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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