GLP-1s Tied to Weight Loss in Peritoneal Dialysis, With Steven Brunelli, MD

Among adults with type 2 diabetes starting peritoneal dialysis (PD), greater cumulative exposure to glucagon-like peptide-1 receptor agonists (GLP-1 RAs) was associated with progressive weight reduction and a lower hospitalization burden.¹

Presented at the American Society of Nephrology (ASN) Kidney Week 2026 in Denver, Colorado, by Steven M. Brunelli, MD, MSCE, an author on the study and vice president and medical director of health analytics and insights at DaVita Clinical Research, the retrospective cohort data suggest the weight loss seen with GLP-1 RAs in the general population may extend to patients on PD. The investigators noted that prospective studies are needed to confirm long-term effects in this population.

Patients on PD with type 2 diabetes face cardiovascular risk, a substantial metabolic burden from dialysate glucose exposure and progressive loss of residual kidney function.¹ In the FLOW trial, semaglutide reduced the risk of death from cardiovascular causes in patients with type 2 diabetes and chronic kidney disease (CKD), but evidence on GLP-1 RA use in PD populations remains limited.¹,²

“In general, dialysis patients, and in particular peritoneal dialysis patients, don’t make it into the landmark clinical trials,” Brunelli said in an interview with HCPLive. “When there’s a big breakthrough, things like GLP-1s that are radically transforming care for patients, we don’t know whether those findings apply in this subset of patients who have their own unique challenges and also their own unique biology.”

How Investigators Tracked GLP-1 RA Exposure in Peritoneal Dialysis

To address this gap in research, the team conducted a retrospective cohort study of 5,897 adults with type 2 diabetes who initiated PD between April 2021 and September 2024. Of those, 516 (8.7%) initiated a GLP-1 RA.¹

Patients were followed from day 90 after PD start, and patient time was assigned to GLP-1 RA use or control based on prescription data. Marginal structural models estimated the average treatment effect in the overlap population, using stabilized inverse probability weights to account for time-varying treatment assignment and censoring.¹

The primary outcome of interest was relative weight change. Secondary outcomes included hospitalization, body surface area (BSA) indexed ultrafiltration and urine output, while HbA1c and mortality were exploratory.¹

GLP-1 RA Exposure, Weight Change and Hospitalization Results

Increasing cumulative GLP-1 RA exposure was associated with progressive weight reduction (−1.19 percentage points [pp]; 95% CI, −1.97 to −0.42; P = .003), with a dose response of −0.73 pp per exposure quarter (P < .001). The association strengthened when the analysis was restricted to new users (−1.69 pp; P < .001).¹

Greater cumulative exposure was also associated with a lower modeled hospitalization burden (incidence rate ratio, 0.935 per exposure quarter; P = .004). BSA indexed ultrafiltration and urine output showed no significant associations.¹

Mortality estimates were directionally protective but imprecise (HR, 0.706; P = .33). HbA1c analyses violated parallel trend assumptions and were interpreted descriptively because of confounding by indication.¹

Brunelli emphasized that the observational design means the findings should inform, rather than settle, clinical decisions, and said he hopes the work builds momentum for a dedicated trial in PD.

“It’s still an observational study. It’s not the same as a clinical trial,” Brunelli said. “In the meantime, for patients who otherwise would be good GLP-1 candidates, our data are consistent with the idea that we shouldn’t deny the patients the GLP-1 specifically because they’re on peritoneal dialysis.”

Editor’s Note: Disclosures for Brunelli include DaVita, Inc.

References

1. Luo J, Sibbel S, Weinhandl ED, et al. GLP-1 receptor agonist exposure and longitudinal outcomes in patients with type 2 diabetes initiating peritoneal dialysis. Abstract presented at: American Society of Nephrology Kidney Week 2026; October 21-25, 2026; Denver, Colorado. Poster FR-PO1115. doi:10.1681/ASN.202657kx8n1h

2. Perkovic V, Tuttle KR, Rossing P, et al. Effects of semaglutide on chronic kidney disease in patients with type 2 diabetes. N Engl J Med. 2024;391(2):109-121. doi:10.1056/NEJMoa2403347