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Two semaglutide pens: Is Ozempic hard on kidneys?
Drug Info

Is Ozempic hard on kidneys?

Weight loss associated with Ozempic use may impact the kidneys both positively and negatively
Sarah Bradley writer headshot
By | Nov. 6, 2024 Medically reviewed by Chad Shaffer, MD

Key takeaways

  • Ozempic doesn’t seem to directly affect kidney function, but because it can promote weight loss, improve blood glucose, and provide cardiovascular protection, it may also lead to better kidney function as a result.

  • People with kidney disease taking Ozempic should be closely monitored, because any type of rapid weight loss or dehydration can cause acute kidney injury, and people with preexisting kidney disease are at a higher risk of developing this complication.

  • A recent study suggests taking semaglutide may delay or slow the progression of chronic kidney disease (CKD) in patients with Type 2 diabetes, though more research is needed to understand that relationship and determine whether semaglutide can be used as a treatment for CKD.

  • At this point, Ozempic is only approved for the treatment of Type 2 diabetes and lowering the risk of cardiovascular events in people with Type 2 diabetes and known heart disease.

In this article:

Ozempic (semaglutide) is a weekly injectable medication approved for the treatment of Type 2 diabetes. It’s a glucagon-like peptide 1 (GLP-1) receptor agonist, that helps lower blood sugar, aid in weight loss, and reduce the risk of cardiovascular disease in those with heart disease.

Ozempic doesn’t seem to directly impact your kidney function, but the changes Ozempic causes in other areas of the body can affect the kidneys. Here’s what to know about how Ozempic affects kidney function—for better and for worse—along with what researchers have been discovering as they evaluate Ozempic’s impact on kidney health.

Is Ozempic hard on kidneys?

“Studies show that Ozempic could be beneficial to kidney health in people living with Type 2 diabetes due to its effects on blood glucose levels and blood pressure,” says Michael Lahey, MD, a physician with My Weight Loss Partner in Michigan. However, it isn’t all smooth sailing. “There are potential complications for people taking Ozempic, with the rapid weight loss the drug causes increasing your risk for acute kidney injury,” Dr. Lahey adds.

“Anyone who experiences rapid weight loss or fluid loss can end up with acute kidney injury (AKI), which can be extreme enough to require hospitalization and even dialysis to recover from,” says Ramesh Khanna, MD, chair of nephrology at MU Health Care. 

Other factors can cause rapid weight loss that leads to AKI, such as training for certain high-intensity sports, so this isn’t unique to Ozempic. But it is something people with existing kidney conditions should be aware of when taking the drug. “It’s less likely to happen if you lose weight slowly and steadily,” says Dr. Khanna, adding that he typically sees AKI in people taking Ozempic when they lose large amounts of weight very quickly, such as 50–100 pounds in a matter of months. 

“You may also be at a higher risk of AKI if you experience severe gastrointestinal side effects from Ozempic,” Dr. Lahey says. Examples include frequent vomiting, diarrhea, and dehydration (especially if you have preexisting kidney disease of any kind). According to the drug’s label, about 20% of patients taking Ozempic 1 mg weekly experience nausea and 9% have diarrhea, and if these effects cause dehydration, AKI could occur.

A study published in 2022 suggests that Saxenda (liraglutide) may be more likely to cause AKI than other types of GLP-1 receptor agonists, like Ozempic. The study was limited by being based on reported side effects in a database, and findings need to be replicated in a prospective trial ideally.

Ozempic and kidney health: The connection

According to Dr. Lahey, Ozempic itself doesn’t target kidney function, but it does provide secondary benefits—like weight reduction, improved blood sugar control, and lower cardiovascular risks—that can help protect kidney health. This is particularly helpful for people with Type 2 diabetes, for whom chronically high blood sugar can cause kidney damage. “Where Ozempic could be beneficial is by helping to lower blood sugar and promote weight loss, which in turn would put less of a burden on the kidneys and support good kidney health over the long run.” Dr. Lahey adds.

Effects of Ozempic (semaglutide) on chronic kidney disease

Most of what we know so far about Ozempic’s effect on chronic kidney disease (CKD) comes from a recent study published in the New England Journal of Medicine. In the study, participants with CKD and Type 2 diabetes taking semaglutide for more than three years had a 24% lower chance of having what researchers called a “major kidney disease event,” including kidney failure, needing dialysis or a transplant, decline in kidney function, and kidney-related or cardiovascular death.

This suggests that semaglutide may be able to delay or slow the progression of CKD in people with Type 2 diabetes, though Dr. Lahey notes more research is needed to determine the safety and efficacy of the treatments used in the study for people with both chronic health conditions.

Can you take Ozempic for chronic kidney disease?

Currently, Ozempic is only approved by the Food and Drug Administration (FDA) for the treatment of Type 2 diabetes and lowering the risk of cardiovascular events in people with Type 2 diabetes and known heart disease. So it’s unlikely a healthcare provider would prescribe Ozempic to someone with only CKD and not Type 2 diabetes (or that an insurance provider would offer coverage for Ozempic in that scenario). 

RELATED: Ozempic for weight loss

As for whether healthcare providers are looking at Ozempic as a possible treatment for CKD in people with Type 2 diabetes, Dr. Lahey says it’s not common practice at this point. While the data is reassuring and it seems like Ozempic may slow the progression of CKD in people with Type 2 diabetes, more significant, long-term studies are needed to understand if and how Ozempic could help manage kidney disease.  

People with Type 2 diabetes and CKD may see improvement in their kidney function while taking Ozempic, because the drug improves other metrics of health (like weight, blood sugar, and cardiovascular health) that reduce the burden on the kidneys. But Dr. Khanna stresses that you should work with your healthcare provider closely to ensure your kidney function isn’t negatively affected by your weight loss. He suggests following a gradual titration schedule (slowly increasing the amount of medication you take) and taking just enough medication to lose weight slowly and steadily, aiming for about 3–5 pounds per month.

If you have CKD but not Type 2 diabetes, or you and your healthcare provider have decided Ozempic isn’t right for you, there are other medications you can take to manage CKD, depending on the cause of your kidney disease. For example, people with diabetes may be able to manage mild CKD by controlling blood sugar effectively with insulin or drugs like metformin and Jardiance. And people with other chronic health conditions like hypertension or heart disease may be prescribed medications like beta blockers and ACE inhibitors. Your healthcare provider is the best person to help you figure out which medications are safe and appropriate for you to take as you manage your co-existing health conditions.