Established GLP-1 receptor agonists such as semaglutide, dulaglutide and liraglutide do not need dose reduction for reduced eGFR. The kidney risk comes from volume depletion when nausea, vomiting or diarrhoea are severe, particularly during dose escalation and in patients also taking diuretics, ACE inhibitors, angiotensin receptor blockers or SGLT2 inhibitors.
Warn patients to seek advice if they cannot keep fluids down, and include these drugs in sick-day guidance.
- Warn patients starting a GLP-1 receptor agonist about dehydration from vomiting or diarrhoea
- Include GLP-1 receptor agonists in sick-day advice alongside diuretics, RAS blockers and SGLT2 inhibitors
- Check creatinine if a patient reports persistent gastrointestinal symptoms
- Escalate the dose slowly in patients with advanced CKD
Why it matters
These drugs protect kidneys long term but can injure them acutely through fluid loss.
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