{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T07:55:34Z","timestamp":1791618934909,"version":"4.3.4"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Semaglutide and other Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated cardiovascular and renal benefits in patients with type 2 diabetes mellitus (T2DM); however, individuals with end-stage renal disease (ESRD) have been systematically excluded from landmark outcome trials. Consequently, real-world data evaluating the safety and effectiveness of GLP-1 RAs in this high-risk population remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicenter retrospective cohort study evaluated adult patients with T2DM and ESRD, including those receiving maintenance hemodialysis, who were prescribed injectable semaglutide between January 2016 and July 2025 at tertiary care centers in Saudi Arabia. The primary efficacy outcomes were changes in glycemic control and insulin requirements following initiation of injectable semaglutide. Secondary outcomes included changes in body weight. Safety outcomes comprised acute kidney injury (AKI), severe hypoglycemia, treatment discontinuation due to adverse events, expanded major adverse cardiovascular events (MACE), and all-cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seventeen patients were included, with a median follow-up of 1,187 days (IQR 602\u20131,442); 58.8% were receiving hemodialysis. Mean HbA1c decreased from 9.06 \u00b1 1.69% to 8.75 \u00b1 2.48% (\u22120.31 \u00b1 2.57%; p = 0.630), with insulin dose reductions observed among the subset of patients with available documentation. Among 16 patients with paired weight measurements, mean body weight decreased by \u221212.63 \u00b1 24.03\u00a0kg (p = 0.074). No cardiovascular deaths, nonfatal myocardial infarctions, or nonfatal strokes were observed. Three expanded MACE events, all hospitalizations for heart failure, occurred during follow-up. AKI occurred in 57.1% of non-dialysis patients, and severe hypoglycemia was reported in two patients (11.8%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In real-world practice, injectable semaglutide was associated with descriptive changes in metabolic parameters in patients with ESRD, including those on hemodialysis. Larger prospective studies are needed to better define the role of GLP-1 RAs in this underrepresented population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1805015","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T05:19:40Z","timestamp":1774502380000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Real-world use of semaglutide in patients with type 2 diabetes and end-stage renal disease: a multicenter retrospective cohort study"],"prefix":"10.3389","volume":"17","author":[{"given":"Omar","family":"Alkhezi","sequence":"first","affiliation":[{"name":"Department of Pharmacy Practice, College of Pharmacy, Qassim University","place":["Al-Qassim Buraydah, Qassim, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lama","family":"Alfehaid","sequence":"additional","affiliation":[{"name":"Pharmacy Practice Department, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences","place":["Riyadh, Saudi Arabia"]},{"name":"Department of Pharmaceutical Care Services, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs","place":["Riyadh, Saudi Arabia"]},{"name":"King Abdullah International Medical Research Center (KAIMRC), Ministry of National Guard Health Affairs (MNGHA)","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amal","family":"Alanezi","sequence":"additional","affiliation":[{"name":"Pharmacy Practice Department, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monirah","family":"Alotaibi","sequence":"additional","affiliation":[{"name":"Pharmacy Practice Department, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Alshaya","sequence":"additional","affiliation":[{"name":"Pharmacy Practice Department, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences","place":["Riyadh, Saudi Arabia"]},{"name":"Department of Pharmaceutical Care Services, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs","place":["Riyadh, Saudi Arabia"]},{"name":"King Abdullah International Medical Research Center (KAIMRC), Ministry of National Guard Health Affairs (MNGHA)","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3390\/molecules25081987","article-title":"Type 2 diabetes mellitus: A review of multi-target drugs","volume":"25","author":"Artasensi","year":"2020","journal-title":"Molecules"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2021.109119","article-title":"IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045","volume":"183","author":"Sun","year":"2022","journal-title":"Diabetes Res Clin Pract"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.2147\/DMSO.S500992","article-title":"Development of predictive models for progression from diabetic kidney disease to end-stage renal disease in type 2 diabetes mellitus: A retrospective cohort study","volume":"18","author":"Hu","year":"2025","journal-title":"Diabetes Metab Syndr Obes"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1053\/j.ackd.2014.03.003","article-title":"Cardiovascular complications of diabetic kidney disease","volume":"21","author":"P\u00e1lsson","year":"2014","journal-title":"Adv Chronic Kidney Dis"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1603827","article-title":"Liraglutide and cardiovascular outcomes in type 2 diabetes","volume":"375","author":"Marso","year":"2016","journal-title":"N Engl J Med"},{"key":"B6","doi-asserted-by":"publisher","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":"B7","doi-asserted-by":"publisher","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":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)31149-3","article-title":"Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND)","volume":"394","author":"Gerstein","year":"2019","journal-title":"Lancet"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(18)30104-9","article-title":"Dulaglutide versus insulin glargine in patients with type 2 diabetes and moderate-to-severe chronic kidney disease (AWARD-7)","volume":"6","author":"Tuttle","year":"2018","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B10","doi-asserted-by":"publisher","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":"B11","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1056\/NEJMoa2032183","article-title":"Once-weekly semaglutide in adults with overweight or obesity","volume":"384","author":"Wilding","year":"2021","journal-title":"N Engl J Med"},{"key":"B12","doi-asserted-by":"publisher","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":"B13","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1056\/NEJMoa1411892","article-title":"A randomized, controlled trial of liraglutide for weight loss","volume":"373","author":"Pi-Sunyer","year":"2015","journal-title":"N Engl J Med"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1804989","article-title":"Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease","volume":"379","author":"Hernandez","year":"2018","journal-title":"N Engl J Med"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1612917","article-title":"Effects of once-weekly exenatide on cardiovascular outcomes in type 2 diabetes","volume":"377","author":"Holman","year":"2017","journal-title":"N Engl J Med"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1509225","article-title":"Lixisenatide in patients with type 2 diabetes and acute coronary syndrome","volume":"373","author":"Pfeffer","year":"2015","journal-title":"N Engl J Med"},{"key":"B17","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1056\/NEJMoa2108269","article-title":"Cardiovascular and renal outcomes with efpeglenatide in type 2 diabetes (AMPLITUDE-O)","volume":"385","author":"Gerstein","year":"2021","journal-title":"N Engl J Med"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.2337\/dc15-1025","article-title":"Safety and efficacy of liraglutide in patients with type 2 diabetes and end-stage renal disease","volume":"39","author":"Idorn","year":"2016","journal-title":"Diabetes Care"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1186\/1758-5996-5-10","article-title":"The efficacy of incretin therapy in patients with type 2 diabetes undergoing hemodialysis","volume":"5","author":"Terawaki","year":"2013","journal-title":"Diabetol Metab Syndr"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfac090","article-title":"Semaglutide for treatment of obesity in hemodialysis patients waiting for a kidney transplant: New hope","volume":"15","author":"Touzot","year":"2022","journal-title":"Clin Kidney J"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdiacomp.2017.12.005","article-title":"Improved glycemic control with once-weekly dulaglutide in addition to insulin therapy in type 2 diabetes mellitus patients on hemodialysis evaluated by continuous glucose monitoring","volume":"32","author":"Yajima","year":"2018","journal-title":"J Diabetes Complications"},{"key":"B22","doi-asserted-by":"publisher","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":"B23","doi-asserted-by":"publisher","first-page":"35","DOI":"10.3810\/pgm.2014.05.2754","article-title":"Effect of renal impairment on the pharmacokinetics, efficacy, and safety of albiglutide","volume":"126","author":"Young","year":"2014","journal-title":"Postgrad Med"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(19)30249-9","article-title":"Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes","volume":"7","author":"Kristensen","year":"2019","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1186\/s12933-023-01793-9","article-title":"The cardiovascular and renal effects of glucagon-like peptide-1 receptor agonists in patients with advanced diabetic kidney disease","volume":"22","author":"Lin","year":"2023","journal-title":"Cardiovasc Diabetol"},{"key":"B26","volume-title":"Ozempic (semaglutide) injection [prescribing information]","year":"2025"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsps.2024.102054","article-title":"The prevalence of cardiovascular diseases, chronic kidney disease, and obesity in patients with type 2 diabetes mellitus and the description of concurrent treatments","volume":"32","author":"Alshaya","year":"2024","journal-title":"Saudi Pharm J"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1159\/000339789","article-title":"KDIGO clinical practice guidelines for acute kidney injury","volume":"120","author":"Khwaja","year":"2012","journal-title":"Nephron Clin Pract"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.2337\/dc26-S009","article-title":"Pharmacologic approaches to glycemic treatment: Standards of care in diabetes\u20142026","volume":"49","year":"2026","journal-title":"Diabetes Care"},{"key":"B30","doi-asserted-by":"publisher","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","volume":"102","year":"2022","journal-title":"Kidney Int"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/j.japh.2023.06.003","article-title":"Glucagon-like peptide-1 receptor agonists use for type 2 diabetes mellitus in end-stage renal disease","volume":"63","author":"Thomas","year":"2023","journal-title":"J Am Pharm Assoc"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/j.eprac.2024.07.008","article-title":"The use of semaglutide in patients with renal failure\u2014A retrospective cohort study","volume":"30","author":"Long","year":"2024","journal-title":"Endocr Pract"},{"key":"B33","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/S2213-8587(24)00271-7","article-title":"Effects of GLP-1 receptor agonists on kidney and cardiovascular disease outcomes: A meta-analysis of randomised controlled trials","volume":"13","author":"Badve","year":"2025","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.1169","article-title":"Association of glucagon-like peptide-1 receptor agonist vs. dipeptidyl peptidase-4 inhibitor use with mortality among patients with type 2 diabetes and advanced chronic kidney disease","volume":"5","author":"Chen","year":"2022","journal-title":"JAMA Netw Open"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(19)30256-6","article-title":"SGLT2 inhibitors for the prevention of kidney failure in patients with type 2 diabetes","volume":"7","author":"Neuen","year":"2019","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1056\/NEJMra1214243","article-title":"Acute kidney injury and chronic kidney disease as interconnected syndromes","volume":"371","author":"Chawla","year":"2014","journal-title":"N Engl J Med"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.4103\/jfcm.JFCM_304_19","article-title":"Incidence and risk factors associated with hypoglycemia among patients with chronic kidney disease","volume":"27","author":"AlEissa","year":"2020","journal-title":"J Family Community Med"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1805015\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T05:19:41Z","timestamp":1774502381000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1805015\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,26]]},"references-count":37,"alternative-id":["10.3389\/fendo.2026.1805015"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1805015","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,26]]},"article-number":"1805015"}}