Real-world study examines semaglutide use in patients with type 2 diabetes and end-stage renal disease

Injectable semaglutide was associated with descriptive changes in metabolic parameters in patients with type 2 diabetes mellitus and end-stage renal disease, including those on hemodialysis, in a multicenter retrospective cohort study. The study evaluated adult patients prescribed injectable semaglutide between January 2016 and July 2025 at tertiary care centers in Saudi Arabia because individuals with end-stage renal disease have been systematically excluded from landmark outcome trials.

Seventeen patients were included, with a median follow-up of 1,187 days (IQR 602-1,442), and 58.8% were receiving hemodialysis. The primary efficacy outcomes were changes in glycemic control and insulin requirements following initiation of injectable semaglutide, while secondary outcomes included changes in body weight.

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).

Safety outcomes comprised acute kidney injury, severe hypoglycemia, treatment discontinuation due to adverse events, expanded major adverse cardiovascular events, and all-cause mortality. No cardiovascular deaths, nonfatal myocardial infarctions, or nonfatal strokes were observed. Three expanded major adverse cardiovascular events, all hospitalizations for heart failure, occurred during follow-up. Acute kidney injury occurred in 57.1% of non-dialysis patients, and severe hypoglycemia was reported in two patients (11.8%).

The study noted that larger prospective studies are needed to better define the role of glucagon-like peptide-1 receptor agonists in this underrepresented population.