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Safety of Semaglutide After Dialysis Initiation: An Individual-Level Pooled Analysis
Klara R Klein1, Anna Menacher2, John B Buse1
1Division of Endocrinology and Metabolism, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Diabetes Care
|March 27, 2026
Summary
Continuing semaglutide after initiating dialysis appears safe for patients at high risk of mortality. Further research is needed to confirm its efficacy in reducing cardiovascular events and death in this population.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Patients on dialysis face high risks of cardiovascular mortality and all-cause mortality.
- Semaglutide has demonstrated cardiovascular benefits in type 2 diabetes and obesity but data in dialysis patients are limited.
Purpose of the Study:
- To assess the safety of continuing semaglutide treatment in patients who initiate dialysis.
Main Methods:
- Post hoc analysis of four randomized, placebo-controlled trials (SUSTAIN-6, SELECT, FLOW, SOUL).
- Systematically collected adverse events (AEs) and serious AEs (SAEs) were evaluated in participants who initiated dialysis.
- Compared outcomes between semaglutide and placebo groups who remained on treatment after dialysis initiation.
Main Results:
- Among 307 participants initiating dialysis, 165 remained on treatment (71 semaglutide, 94 placebo).
- Serious adverse events occurred in 45% of the semaglutide group versus 57% of the placebo group.
- Major adverse cardiovascular events (MACE) and all-cause mortality rates were lower in the semaglutide group compared to placebo.
Conclusions:
- Continuation of semaglutide after dialysis initiation appears safe.
- Further efficacy testing is warranted to confirm semaglutide's role in reducing MACE and mortality in dialysis patients.
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