Among adults living with type 2 diabetes who have just begun peritoneal dialysis, a quiet signal has surfaced: those who took more GLP-1 receptor agonists tended to lose more weight and spend fewer days in hospital. It is the kind of finding that rests on a long human tradition of watching patients closely and asking what helps them, yet it arrives without the certainty of a controlled experiment. Clinicians have long known that people on dialysis are rarely included in the trials that shape modern medicine, so they are left to reason from observation whether a new therapy belongs in their car
GLP-1s Linked to Weight Loss and Fewer Hospitalizations in Peritoneal Dialysis Patients
Dialysis patients rarely make it into the landmark trials.
Mark
Why does a study of about 500 GLP-1 users matter when the cohort is nearly 6,000?
Mimi
Because peritoneal dialysis patients are usually left out of big trials. Brunelli's point is that nobody knew whether the GLP-1 benefits carried over to them.
Luke
Worth saying the 516 users are 8.7% of the cohort, and this is retrospective. It shows association, not cause.
Mark
What are the headline numbers?
Mimi
Weight fell 1.19 percentage points with greater cumulative exposure, and 0.73 points per quarter of exposure. Hospitalization burden dropped, with an incidence rate ratio of 0.935 per quarter.
Luke
Those are modeled figures. The weight loss is modest, and the source doesn't say what it means in kilograms.
Mark
And mortality?
Mimi
The direction looked protective, with an HR of 0.706.
Luke
But P was .33. That's imprecise, so I wouldn't lean on it. HbA1c was also only descriptive because of confounding by indication.
Mark
So what should a clinician take from it?
Mimi
Brunelli says peritoneal dialysis alone shouldn't be a reason to withhold a GLP-1 from an otherwise good candidate.
Luke
Fair, as long as it's read as consistent with that idea, not proof. A trial is still missing.
Il Polso
- A retrospective look at 5,897 dialysis patients with diabetes has found that more GLP-1 use tracked with steady weight loss and fewer hospitalizations.
- The people who matter most, peritoneal dialysis patients, have been largely absent from landmark trials, leaving clinicians to guess whether breakthroughs apply to them.
- Researchers adjusted their statistics for changing treatment and dropouts, yet the design still cannot rule out hidden differences between those who received the drug and those who did not.
- Mortality and HbA1c results remained uncertain or inconclusive, so the protective signals are suggestive rather than settled.
- The authors are not recommending a dedicated trial yet, but they are pressing for one, and for now they suggest patients should not be denied a GLP-1 simply because they are on dialysis.
Among adults living with type 2 diabetes who have just begun peritoneal dialysis, a quiet signal has surfaced: those who took more GLP-1 receptor agonists tended to lose more weight and spend fewer days in hospital. It is the kind of finding that rests on a long human tradition of watching patients closely and asking what helps them, yet it arrives without the certainty of a controlled experiment. Clinicians have long known that people on dialysis are rarely included in the trials that shape modern medicine, so they are left to reason from observation whether a new therapy belongs in their care at all. This work offers a careful, provisional answer and a clear invitation to test it properly.
At ASN Kidney Week 2026 in Denver, a poster numbered FR-PO1115 offered dialysis clinicians something they have rarely had: data on a question they face daily. Among adults with type 2 diabetes who start peritoneal dialysis, those with greater exposure to GLP-1 receptor agonists lost more weight and were hospitalized less often.
Steven M. Brunelli, MD, MSCE, of DaVita Clinical Research, presented the work. The study is retrospective, and its authors say prospective trials are needed before anyone can claim long-term benefit in this population.
The need is familiar. People on peritoneal dialysis with diabetes carry heavy cardiovascular risk, a metabolic load from glucose in the dialysate, and a gradual loss of residual kidney function. Semaglutide has shown cardiovascular benefit in broader kidney populations, but evidence specific to peritoneal dialysis is thin. Brunelli noted that dialysis patients generally do not enter landmark trials, leaving it unclear whether a breakthrough applies to them at all.
The team followed 5,897 adults who began peritoneal dialysis between 2021 and 2024, 516 of whom started a GLP-1 receptor agonist. Using prescription data and weighting methods designed to handle changing treatment and dropouts, they found a weight reduction of 1.19 percentage points with more cumulative exposure, a larger drop among new users, and a lower modeled hospitalization burden. Ultrafiltration and urine output showed no clear link. Mortality estimates leaned protective but were too imprecise to trust, and HbA1c results could not be interpreted firmly.
Brunelli was candid about the limits. "It's still an observational study," he said. For suitable patients, the data are consistent with not withholding a GLP-1 solely because they are on dialysis, and he hopes the findings will help build the case for a dedicated trial in this group.
At ASN Kidney Week 2026 in Denver, a poster numbered FR-PO1115 carried a result that dialysis clinicians have had few data to lean on. Among adults with type 2 diabetes who start peritoneal dialysis, the more exposure they had to GLP-1 receptor agonists, the more weight they lost and the less they were hospitalized.
Steven M. Brunelli, MD, MSCE, an author on the study, presented the findings. He is vice president and medical director of health analytics and insights at DaVita Clinical Research. The data are retrospective, and the investigators say prospective studies are needed to confirm long-term effects in this population.
The gap the work addresses is a familiar one. People on peritoneal dialysis with type 2 diabetes carry cardiovascular risk, a substantial metabolic burden from glucose in the dialysate, and a steady loss of residual kidney function. In the FLOW trial, semaglutide reduced the risk of cardiovascular death in people with type 2 diabetes and chronic kidney disease, but evidence in peritoneal dialysis specifically remains limited. Brunelli told HCPLive that dialysis patients, and peritoneal dialysis patients in particular, generally do not make it into landmark trials. When a breakthrough arrives, he said, it is unclear whether it applies to a group with its own challenges and its own biology.
The team studied 5,897 adults with type 2 diabetes who began peritoneal dialysis between April 2021 and September 2024. Of them, 516, or 8.7%, started a GLP-1 receptor agonist. Follow-up began on day 90 after dialysis start, and patient time was assigned to GLP-1 use or control according to prescription data. Marginal structural models with stabilized inverse probability weights estimated the average treatment effect in the overlap population, accounting for treatment that changed over time and for censoring.
The primary outcome was relative weight change. Secondary outcomes were hospitalization, body surface area-indexed ultrafiltration, and urine output. HbA1c and mortality were exploratory.
Greater cumulative exposure was associated with progressive weight reduction of 1.19 percentage points (95% CI, −1.97 to −0.42; P = .003), with a dose response of −0.73 points per quarter of exposure (P < .001). Restricting the analysis to new users strengthened the association to −1.69 points (P < .001). Higher exposure was also tied to a lower modeled hospitalization burden, with an incidence rate ratio of 0.935 per exposure quarter (P = .004).
Other results were less clear. Ultrafiltration and urine output showed no significant associations. Mortality estimates leaned protective but were imprecise (HR, 0.706; P = .33). The HbA1c analyses violated parallel trend assumptions, so the authors interpreted them descriptively, citing confounding by indication.
Brunelli stressed that the design limits what the data can settle. "It's still an observational study," he said, adding that it is not the same as a clinical trial. For patients who would otherwise be good candidates, he said, the data are consistent with not denying them a GLP-1 solely because they are on peritoneal dialysis. He hopes the work builds momentum for a dedicated trial in this group. His disclosures include DaVita, Inc.
Citazioni salienti
It's still an observational study. It's not the same as a clinical trial.— Steven M. Brunelli, MD, MSCE, DaVita Clinical Research
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