GLP-1 Receptor Agonists Linked to Lower Mortality and Increased Transplant Waitlisting in Dialysis Patients With Diabetes
Key Clinical Summary
- GLP-1 receptor agonist use in dialysis patients with type 2 diabetes was associated with 23% lower mortality risk.
- Users experienced significantly greater body mass index (BMI) and weight reduction compared to non-users.
- Increased risk of diabetic retinopathy was observed, but no other major safety signals were detected.
Introduction
At ObesityWeek 2025, new data presented in session Oral-001 revealed that GLP-1 receptor agonist therapy is associated with improved survival and weight loss in patients with type 2 diabetes on dialysis. This national cohort study is the largest to date to evaluate real-world safety and outcomes of GLP-1 agents in this high-risk population.
Session Highlights
The study, conducted using the United States Renal Data System from 2013 to 2021, evaluated 151 649 adults with type 2 diabetes initiating dialysis. Among this cohort, patients who received GLP-1 receptor agonists experienced significantly improved outcomes across multiple measures.
Key findings included:
- BMI reduction of −1.47 kg/m² among GLP-1 users versus −0.61 kg/m² in non-users (P<0.001).
- Weight loss of −4.03 kg in users versus −1.47 kg in non-users (P < 0.001).
- All-cause mortality incidence was 219.0 per 1,000 person-years in GLP-1 users compared to 279.5 in non-users (P < 0.001).
- Adjusted hazard ratio for mortality: 0.77 (95% CI: 0.70–0.85; P < 0.001).
Additionally, GLP-1 use was associated with a 66% increased likelihood of being placed on the kidney transplant waitlist (aHR: 1.66; 95% CI: 1.28–2.13; P < 0.001). Safety analysis identified a statistically significant association with diabetic retinopathy (aHR: 1.32; 95% CI: 1.12–1.56; P = 0.001), but not with pancreatitis, biliary disease, or thyroid cancer.
Findings were consistent across multiple sensitivity analyses, including subgroup analyses of Medicaid-eligible patients.
Expert Perspectives
Presenters emphasized that GLP-1 receptor agonists may offer a dual benefit of cardiometabolic improvement and enhanced transplant eligibility in a population often excluded from randomized clinical trials. They noted the robustness of the findings across patient subgroups and statistical models. However, they also highlighted the need for closer monitoring of diabetic retinopathy, particularly given the elevated risk signal identified.
According to the investigators, the findings support expanded consideration of GLP-1 therapy for diabetes management in dialysis patients, especially those with obesity and transplant potential. These real-world data address a major evidence gap in nephrology pharmacotherapy.
Implications for Practice
For nephrologists and endocrinologists managing diabetes in patients on dialysis, this study provides the strongest evidence to date supporting the efficacy, survival benefit, and weight reduction potential of GLP-1 receptor agonists. However, the observed risk for diabetic retinopathy warrants baseline screening and follow-up retinal evaluations.
Conclusion
This large-scale analysis supports GLP-1 receptor agonists as a potentially transformative treatment in dialysis patients with type 2 diabetes, with significant survival and metabolic benefits. Future trials and guidelines may further define their role in this underserved population.
Reference
Gudzune K A, Orandi B J, Chen Y, et al. Oral-001 GLP-1 receptor agonist outcomes, safety, and BMI change in a national cohort of dialysis patients. Presented at the ObesityWeek; November 4-7, 2025. Atlanta, Georgia.
