Diabetes & Endocrinology
COHORT
● Cohort
Can a diabetes drug help people with kidney failure? A small study looks for clues.
Frontiers in Medicine
Published April 1, 2026
Imagine trying to manage diabetes when your kidneys have already failed. It's a complex and high-stakes balancing act. Doctors recently took a real-world look at whether a medication called injectable semaglutide, often used for type 2 diabetes, might play a role for these vulnerable patients.
They reviewed the records of 17 adults with both conditions, most of whom were on dialysis. Over roughly three years, using the drug was descriptively linked to an average weight loss of about 12.6 kilograms. Some patients also needed less insulin. The average change in long-term blood sugar (HbA1c) was a slight decrease, but this finding wasn't statistically significant, meaning it could be due to chance.
It's crucial to view these findings as a first, cautious look. The study was very small and retrospective, meaning it looked back at existing records rather than testing the drug in a controlled trial. While there were no heart attacks or strokes, three patients were hospitalized for heart failure. More than half of the patients not on dialysis showed signs of acute kidney injury, and two patients experienced severe low blood sugar.
This research doesn't prove the drug causes these changes or is broadly safe for this group. Instead, it provides a real-world snapshot that says, 'This might be worth investigating properly.' The clear message from the researchers is that large, prospective studies are urgently needed to understand if and how this medication can help people living with this difficult dual diagnosis.
View Original Abstract ↓
BackgroundSemaglutide and other Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated cardiovascular and renal benefits in patients with type 2 diabetes mellitus (T2DM); however, individuals with end-stage renal disease (ESRD) have been systematically excluded from landmark outcome trials. Consequently, real-world data evaluating the safety and effectiveness of GLP-1 RAs in this high-risk population remain limited.MethodsThis multicenter retrospective cohort study evaluated adult patients with T2DM and ESRD, including those receiving maintenance hemodialysis, who were prescribed injectable semaglutide between January 2016 and July 2025 at tertiary care centers in Saudi Arabia. The primary efficacy outcomes were changes in glycemic control and insulin requirements following initiation of injectable semaglutide. Secondary outcomes included changes in body weight. Safety outcomes comprised acute kidney injury (AKI), severe hypoglycemia, treatment discontinuation due to adverse events, expanded major adverse cardiovascular events (MACE), and all-cause mortality.ResultsSeventeen patients were included, with a median follow-up of 1,187 days (IQR 602–1,442); 58.8% were receiving hemodialysis. Mean HbA1c decreased from 9.06 ± 1.69% to 8.75 ± 2.48% (−0.31 ± 2.57%; p = 0.630), with insulin dose reductions observed among the subset of patients with available documentation. Among 16 patients with paired weight measurements, mean body weight decreased by −12.63 ± 24.03 kg (p = 0.074). No cardiovascular deaths, nonfatal myocardial infarctions, or nonfatal strokes were observed. Three expanded MACE events, all hospitalizations for heart failure, occurred during follow-up. AKI occurred in 57.1% of non-dialysis patients, and severe hypoglycemia was reported in two patients (11.8%).ConclusionsIn real-world practice, injectable semaglutide was associated with descriptive changes in metabolic parameters in patients with ESRD, including those on hemodialysis. Larger prospective studies are needed to better define the role of GLP-1 RAs in this underrepresented population.
