GLP-1 receptor agonists such as Ozempic and Wegovy, widely used for diabetes treatment and weight management, have been found to potentially reduce the risk of certain patients requiring major kidney treatment. Researchers at the Mayo Clinic found that the medications were associated with a lower risk of dialysis and kidney transplantation among those with bipolar disorder, a mental health condition, and chronic kidney disease. The finding is notable given that individuals with bipolar disorder face higher rates of chronic kidney disease and premature mortality than those without the condition, and the researchers say they remain "underrepresented" in related trials.
The study was published in the Journal of Affective Disorders. Bipolar disorder affects a person’s mood, energy, activity and thought, and is characterized by manic and depressive episodes, where mood can swing from one extreme to another, as well as a huge range of other symptoms. It has been estimated that around 4.4 percent of U.S. adults will experience the condition at some point in their lives.
Rates of chronic kidney disease are higher among those with bipolar disorder, and one theory behind the association points towards long-term lithium use. Lithium is an effective mood stabilizer, and is used as a drug therapy to prevent bipolar disorder relapse. However, studies have found that long-term use of the drug may be behind significantly higher declines in estimated glomerular filtration rate (eGFR), a blood marker used to determine how well a person's kidneys are functioning.
"Although it remains the most effective long-term mood stabilizer we have, over years it can injure the kidney," Dr Jai Radhakrishnan, a professor of medicine at Columbia University, told Newsweek, adding that in some patients it may cause kidney scarring. "Unless practitioners monitor lithium levels and kidney function closely, this kidney injury can progress to kidney failure," he said. Dr Jordy Cohen, an assistant professor of medicine and epidemiology at the University of Pennsylvania, told Newsweek that other theories are also under investigation and it is likely down to a "combination of factors, including exposure to medications to treat their bipolar disorder that directly increase the risk for kidney disease (like lithium) or that indirectly increase the risk for kidney disease, by increasing the development of metabolic risk factors such as obesity and diabetes." She also said that people with bipolar disorder are also "at risk for socioeconomic disadvantage, a major risk factor for kidney disease." "There is also some research suggesting their elevated risk may be due to increased underlying inflammation and oxidative stress," she said.
The researchers analyzed data from TriNetX, an international research network that has records from around 131 million adults in 117 health systems. They found that across a sample of around 1.5 million adults with bipolar disorder, around 96,000 also had chronic kidney disease. Among those with bipolar disorder and mild-to-moderate kidney disease, they logged which participants had recently started taking a GLP-1 medication, DPP-4 inhibitors (which are used to treat diabetes), or RAAS inhibitors (which are commonly prescribed for chronic kidney disease).
After following the participants for five years, the researchers found that the group with both conditions, who were also taking GLP-1 medication, were less likely to have had dialysis—a medical procedure used to remove waste products from the body when the kidneys are not working as they should—or kidney transplantation. They found a 44 percent relative reduction, although while this sounds "dramatic," Radhakrishnan said the difference was about 3 to 5 percentage points over five years. He also noted that, because the main comparison drug was a diabetes medication, "these results mostly apply to people with diabetes.
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