{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T06:58:29Z","timestamp":1787295509427,"version":"build-2736575974"},"reference-count":30,"publisher":"American Diabetes Association","issue":"6","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>People receiving dialysis are at high risk of cardiovascular and all-cause mortality. Semaglutide reduces major adverse cardiovascular events (MACE) in people with type 2 diabetes (T2D) and those without T2D with obesity and high cardiovascular risk. Data to establish safety and efficacy in dialysis-dependent kidney failure are scarce. We aimed to assess the safety of semaglutide in people who initiate dialysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>In this post hoc analysis of four randomized, placebo-controlled trials (Trial to Evaluate Cardiovascular and Other Long-term Outcomes With Semaglutide in Subjects With Type 2 Diabetes [SUSTAIN-6], Semaglutide Effects on Cardiovascular Outcomes in People with Overweight or Obesity [SELECT], Evaluate Renal Function With Semaglutide Once Weekly [FLOW], and Semaglutide Cardiovascular Outcomes [SOUL]), we evaluated systematically collected adverse events (AEs) from participants who initiated dialysis during study follow-up. We compared the proportion and event rates of systematically collected serious AEs (SAEs), including adjudicated MACE, and AEs leading to permanent treatment discontinuation in participants originally randomized to semaglutide or placebo who remained on treatment after dialysis initiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Among 34,064 participants randomized across the trials, 307 initiated dialysis, of whom 165 participants randomized to semaglutide (n = 71) or placebo (n = 94) remained on treatment. After dialysis initiation, SAEs were reported in 32 of 71 (45%) and 54 of 94 (57%) participants, and the proportion of participants who permanently discontinued trial medication was 8.5% and 10.6% in the semaglutide and placebo groups, respectively. The MACE event rates were 9.7 and 16.1 events per 100 person-years, and all-cause mortality event rates were 13.8 and 18.1 events per 100 person-years, in the semaglutide and placebo groups, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Although more evidence is needed, continuation of semaglutide after dialysis initiation appears safe and warrants efficacy testing regarding reduction in MACE and death.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc26-0112","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T15:13:43Z","timestamp":1774624423000},"page":"999-1005","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":3,"title":["Safety of Semaglutide After Dialysis Initiation: An Individual-Level Pooled Analysis"],"prefix":"10.2337","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5894-9054","authenticated-orcid":false,"given":"Klara R.","family":"Klein","sequence":"first","affiliation":[{"name":"Division of Endocrinology and Metabolism, University of North Carolina at Chapel Hill 1 , Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Menacher","sequence":"additional","affiliation":[{"name":"Novo Nordisk A\/S 2 , S\u00f8borg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John B.","family":"Buse","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, University of North Carolina at Chapel Hill 1 , Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes F.E.","family":"Mann","sequence":"additional","affiliation":[{"name":"University Hospital Erlangen 3 , Erlangen, Germany"},{"name":"KfH Kidney Centre 4 , Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2235-0103","authenticated-orcid":false,"given":"Katherine R.","family":"Tuttle","sequence":"additional","affiliation":[{"name":"Division of Nephrology, University of Washington 5 , Seattle, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kajsa","family":"Kvist","sequence":"additional","affiliation":[{"name":"Novo Nordisk A\/S 2 , S\u00f8borg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margit R.","family":"Andersen","sequence":"additional","affiliation":[{"name":"Novo Nordisk A\/S 2 , S\u00f8borg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Mayrdorfer","sequence":"additional","affiliation":[{"name":"Novo Nordisk A\/S 2 , S\u00f8borg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7006-7401","authenticated-orcid":false,"given":"Ildiko","family":"Lingvay","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine\/Endocrinology and Peter O\u2019Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center 6 , Dallas, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"2026061812563260100_B1","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1681\/ASN.2018050531","article-title":"Projecting ESRD incidence and prevalence in the United States through 2030","volume":"30","author":"McCullough","year":"2019","journal-title":"J Am Soc Nephrol"},{"key":"2026061812563260100_B2","doi-asserted-by":"crossref","first-page":"1559","DOI":"10.1001\/jama.2024.16338","article-title":"Dialysis for chronic kidney failure: a review","volume":"332","author":"Flythe","year":"2024","journal-title":"JAMA"},{"key":"2026061812563260100_B3","doi-asserted-by":"crossref","first-page":"1975","DOI":"10.1016\/S0140-6736(14)61601-9","article-title":"Worldwide access to treatment for end-stage kidney disease: a systematic review","volume":"385","author":"Liyanage","year":"2015","journal-title":"Lancet"},{"key":"2026061812563260100_B4","unstructured":"United States Renal Data System\n          . USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States.Bethesda, MD, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2023"},{"key":"2026061812563260100_B5","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/S0140-6736(16)30508-6","article-title":"The heart and vascular system in dialysis","volume":"388","author":"Wanner","year":"2016","journal-title":"Lancet"},{"key":"2026061812563260100_B6","doi-asserted-by":"crossref","first-page":"1834","DOI":"10.1056\/NEJMoa1607141","article-title":"Semaglutide and cardiovascular outcomes in patients with type 2 diabetes","volume":"375","author":"Marso","year":"2016","journal-title":"N Engl J Med"},{"key":"2026061812563260100_B7","doi-asserted-by":"crossref","first-page":"2221","DOI":"10.1056\/NEJMoa2307563","article-title":"Semaglutide and cardiovascular outcomes in obesity without diabetes","volume":"389","author":"Lincoff","year":"2023","journal-title":"N Engl J Med"},{"key":"2026061812563260100_B8","doi-asserted-by":"crossref","first-page":"2409","DOI":"10.1056\/NEJMoa2505928","article-title":"Cardiovascular outcomes with tirzepatide versus dulaglutide in type 2 diabetes","volume":"393","author":"Nicholls","year":"2025","journal-title":"N Engl J Med"},{"key":"2026061812563260100_B9","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/S2213-8587(21)00203-5","article-title":"Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of randomised trials","volume":"9","author":"Sattar","year":"2021","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2026061812563260100_B10","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1056\/NEJMoa2403347","article-title":"Effects of semaglutide on chronic kidney disease in patients with type 2 diabetes","volume":"391","author":"Perkovic","year":"2024","journal-title":"N Engl J Med"},{"key":"2026061812563260100_B11","doi-asserted-by":"crossref","first-page":"S111","DOI":"10.2337\/dc21-S009","article-title":"Pharmacologic approaches to glycemic treatment: Standards of Medical Care in Diabetes\u20142021","volume":"44","author":"American Diabetes A. 9","year":"2021","journal-title":"Diabetes Care"},{"key":"2026061812563260100_B12","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.kint.2022.06.008","article-title":"KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease (CKD)","volume":"102","author":"Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group","year":"2022","journal-title":"Kidney Int"},{"key":"2026061812563260100_B13","doi-asserted-by":"crossref","first-page":"S117","DOI":"10.1016\/j.kint.2023.10.018","article-title":"KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (CKD)","volume":"105","author":"Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group","year":"2024","journal-title":"Kidney Int"},{"key":"2026061812563260100_B14","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1038\/s41591-024-03327-6","article-title":"Semaglutide in patients with overweight or obesity and chronic kidney disease without diabetes: a randomized double-blind placebo-controlled clinical trial","volume":"31","author":"Apperloo","year":"2025","journal-title":"Nat Med"},{"key":"2026061812563260100_B15","doi-asserted-by":"crossref","first-page":"126","DOI":"10.2337\/dc22-0659","article-title":"Antihyperglycemic medication use among U.S. adults with hemodialysis-dependent kidney disease and comorbid diabetes","volume":"45","author":"Klein","year":"2022","journal-title":"Diabetes Care"},{"key":"2026061812563260100_B16","doi-asserted-by":"crossref","first-page":"164","DOI":"10.2337\/dci24-0081","article-title":"Glycemic management and individualized diabetes care in dialysis-dependent kidney failure","volume":"48","author":"Klein","year":"2025","journal-title":"Diabetes Care"},{"key":"2026061812563260100_B17","doi-asserted-by":"crossref","first-page":"1925","DOI":"10.1007\/s00125-022-05787-2","article-title":"Management of hyperglycaemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)","volume":"65","author":"Davies","year":"2022","journal-title":"Diabetologia"},{"key":"2026061812563260100_B18","article-title":"A randomized trial examining the effect of subcutaneous semaglutide on kidney transplant candidacy for patients with stage 4-5 CKD or dialysis-dependent ESKD","author":"Geisinger Clinic","year":"2021"},{"key":"2026061812563260100_B19","article-title":"Semaglutide for dialysis-treated patients - a glucose time in range study - DIALYSIS-TIR Study","author":"University of Texas Southwestern Medical Center","year":"2023"},{"key":"2026061812563260100_B20","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1056\/NEJMoa1901118","article-title":"Oral semaglutide and cardiovascular outcomes in patients with type 2 diabetes","volume":"381","author":"Husain","year":"2019","journal-title":"N Engl J Med"},{"key":"2026061812563260100_B21","doi-asserted-by":"crossref","first-page":"2001","DOI":"10.1056\/NEJMoa2501006","article-title":"Oral semaglutide and cardiovascular outcomes in high-risk type 2 diabetes","volume":"392","author":"McGuire","year":"2025","journal-title":"N Engl J Med"},{"key":"2026061812563260100_B22","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1038\/s41581-021-00518-z","article-title":"Patient-centred approaches for the management of unpleasant symptoms in kidney disease","volume":"18","author":"Kalantar-Zadeh","year":"2022","journal-title":"Nat Rev Nephrol"},{"key":"2026061812563260100_B23","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1111\/nep.13243","article-title":"Gastrointestinal symptoms in patients receiving dialysis: a systematic review","volume":"23","author":"Zuvela","year":"2018","journal-title":"Nephrology (Carlton)"},{"key":"2026061812563260100_B24","doi-asserted-by":"crossref","first-page":"100","DOI":"10.2337\/dc21-1579","article-title":"Hypoglycemic and hyperglycemic crises among U.S. adults with diabetes and end-stage kidney disease: population-based study, 2013\u20132017","volume":"45","author":"Galindo","year":"2022","journal-title":"Diabetes Care"},{"key":"2026061812563260100_B25","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1159\/000510613","article-title":"The glycemic effect of liraglutide evaluated by continuous glucose monitoring in persons with type 2 diabetes receiving dialysis","volume":"145","author":"Bomholt","year":"2021","journal-title":"Nephron"},{"key":"2026061812563260100_B26","doi-asserted-by":"crossref","first-page":"206","DOI":"10.2337\/dc15-1025","article-title":"Safety and efficacy of liraglutide in patients with type 2 diabetes and end-stage renal disease: an investigator-initiated, placebo-controlled, double-blind, parallel-group, randomized trial","volume":"39","author":"Idorn","year":"2016","journal-title":"Diabetes Care"},{"key":"2026061812563260100_B27","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1016\/j.jdiacomp.2018.05.018","article-title":"The effect of dulaglutide on body composition in type 2 diabetes mellitus patients on hemodialysis","volume":"32","author":"Yajima","year":"2018","journal-title":"J Diabetes Complications"},{"key":"2026061812563260100_B28","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1053\/j.ajkd.2005.05.020","article-title":"Association of morbid obesity and weight change over time with cardiovascular survival in hemodialysis population","volume":"46","author":"Kalantar-Zadeh","year":"2005","journal-title":"Am J Kidney Dis"},{"key":"2026061812563260100_B29","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1186\/s12933-024-02364-2","article-title":"Mortality and cardiovascular events in diabetes mellitus patients at dialysis initiation treated with glucagon-like peptide-1 receptor agonists","volume":"23","author":"Lai","year":"2024","journal-title":"Cardiovasc Diabetol"},{"key":"2026061812563260100_B30","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.2215\/CJN.0000000750","article-title":"GLP-1 receptor agonist outcomes, safety, and body mass index change in a national cohort of patients on dialysis","volume":"20","author":"Orandi","year":"2025","journal-title":"Clin J Am Soc Nephrol"}],"container-title":["Diabetes Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/49\/6\/999\/860633\/dc260112.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/49\/6\/999\/860633\/dc260112.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T16:56:42Z","timestamp":1781801802000},"score":1,"resource":{"primary":{"URL":"https:\/\/diabetesjournals.org\/care\/article\/49\/6\/999\/164644\/Safety-of-Semaglutide-After-Dialysis-Initiation-An"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,27]]},"references-count":30,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,3,27]]},"published-print":{"date-parts":[[2026,6,1]]}},"URL":"https:\/\/doi.org\/10.2337\/dc26-0112","relation":{},"ISSN":["0149-5992","1935-5548"],"issn-type":[{"value":"0149-5992","type":"print"},{"value":"1935-5548","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,27]]}}}