Perioperative and Renal Outcomes After Nephrectomy in Patients Receiving Glucagon-Like Peptide-1 Receptor Agonists: A Pilot Study.

INTRODUCTION

Patients with elevated BMI undergoing nephrectomy are at increased risk of acute kidney injury (AKI) and perioperative complications. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) may confer renal-protective and anti-inflammatory effects while reducing perinephric adiposity. Thus, we aimed to determine whether GLP-1RA use is associated with fewer perioperative complications following nephrectomy.

METHODS

We conducted a retrospective, national claims analysis of patients undergoing nephrectomy from June 2021 to October 2025. Patients with BMI ≥ 27 kg/m2 undergoing nephrectomy for renal neoplasms were included. Patients receiving GLP-1RA therapy within 180 days of surgery were 1:1 propensity matched by demographics (age, sex, race), comorbidities (body mass index, chronic kidney disease, hypertension, hyperlipidemia, diabetes mellitus, tobacco use), and metformin/sodium-glucose cotransporter-2 inhibitor use. Outcomes included 30-day and 90-day adverse events overall and stratified by partial and radical nephrectomy.

RESULTS

After 1:1 matching, 980 individuals on GLP-1RAs were well balanced with 980 controls from a pool of 36,382 eligible patients. At 30 days, GLP-1RA use was associated with lower rate of hospital readmission (odds ratio [OR] = 0.72; P = .011). At 90 days, GLP-1RA users had a reduced incidence of venous thromboembolism (OR = 0.62; P = .035) and readmission (OR = 0.62; P < .001). Those on GLP-1RA therapy had significantly lower odds of 90-day AKI (OR = 0.76; P = .031) and major adverse kidney events (MAKEs; OR = 0.56; P = .004). MAKE was significantly lower for partial (OR = 0.45; P = .0024) and radical (OR = 0.54; P = .0014) nephrectomy.

CONCLUSIONS

Preoperative GLP-1RA use appeared to reduce rates of AKI, MAKE, and 30/90-day readmission among patients undergoing nephrectomy. These findings suggest GLP-1RAs may mitigate postoperative risk without increasing gastrointestinal, respiratory, or systemic morbidity.