Long-Term Safety and Renal Outcomes of Semaglutide in Non-Diabetic Obesity with Chronic Kidney Disease or Hypertension: A Systematic Review and Meta-Analysis.

BACKGROUND

Semaglutide, a GLP-1 receptor agonist, has demonstrated metabolic and renal benefits in diabetic populations. However, its efficacy and safety in non-diabetic individuals with obesity and chronic kidney disease (CKD) remain largely unstudied. Given the high cardiometabolic risk in this group and limited therapeutic options, evaluating semaglutide's role is crucial.

OBJECTIVE

To assess the effects of semaglutide on body mass index (BMI), blood pressure, renal function (eGFR), and albuminuria in non-diabetic patients with obesity and CKD or hypertension.

METHODS

This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. A total of 580 studies were screened; 3 eligible studies (n=430 participants) were included. Data were extracted from a randomized controlled trial, a real-world observational dialysis study, and a large post hoc trial analysis. Fixed-effect meta-analysis models were applied to estimate pooled effects on BMI, systolic blood pressure (SBP), and renal outcomes.

RESULTS

Semaglutide treatment significantly reduced BMI (mean reduction: Tuttle 18.3%, Apperloo 11.8%, Vanek 1.5%; P = 0.001), and improved hypertension control (SBP <130 mmHg: Apperloo 20.6%, Vanek 12.5%, Tuttle 17.6%; P < 0.02). Renal function also improved, with eGFR >30 ml/min/1.73m² increasing from baseline in all studies (Apperloo 65.8%, Vanek 4.83%, Tuttle 36.4%; P < 0.001). No publication bias was detected.

CONCLUSIONS

Semaglutide is effective and well-tolerated in non-diabetic patients with obesity and CKD, resulting in significant weight loss, better blood pressure control, and improved renal parameters. These findings support its expanded use in non-diabetic CKD populations, including dialysis-dependent individuals.