Ozempic also has positive effect in chronic kidney disease

 The diabetes drug semaglutide, also known as Ozempic, has a positive effect on patients with chronic kidney disease and obesity. The amount of protein in their urine decreased, as did the degree of inflammation of their kidneys and their blood pressure.

This was shown in an international study led by clinical pharmacologist Hiddo L. Heerspink of the University Medical Center Groningen in the Netherlands. This is the first time that it has been shown that this diabetes drug, now best known as a means of losing weight, is also effective for patients with chronic kidney damage.

The results of this study have been published in Nature Medicine and presented simultaneously at the annual congress of the American Society of Nephrology.

Hiddo L. Heerspink got the idea for this study at the beginning of the corona pandemic. Earlier, he had discovered that another class of drugs against type 2 diabetes, the so-called SGLT2 inhibitors, also appeared to work well for patients with chronic kidney damage without diabetes. He therefore wanted to investigate whether semaglutide would also work positively for patients with chronic kidney disease and obesity.

The first participants started this study in the second half of 2022. At that time, it had become increasingly known that semaglutide caused weight loss. As a result, getting participants excited about this study was no problem at all. A lot of patients wanted the drug but could no longer get it because production could not keep up with demand. This study gave them a 50% chance of getting the drug though.

Amount of protein in urine halved

The study was conducted in four countries: Canada, Germany, Spain and the Netherlands. Half of the 101 participants received 24-week injections of semaglutide, while the other half received a placebo. The study found that the amount of protein in urine, an outcome measure indicating the degree of kidney damage, was reduced by as much as 52%.

Furthermore, the degree of kidney inflammation was found to decrease by 30%, the participants' blood pressure drop was as large as a blood pressure-lowering drug gives, and in them, a key measure of heart failure was reduced by 33%. Participants also lost about 10% of their weight.

Heerspink is very enthusiastic about these outcomes. "The great thing is that the drug has both direct and indirect effects on the kidneys. The drug has direct effects on inflammation parameters in the kidney, and lowers fat tissue around the kidneys, lowering the amount of protein in the urine. And indirectly, because it reduces participants' weight and blood pressure."

The study was too short to measure improvement in participants' quality of life or medium-term effects. "We sent the participants questionnaires about their diet. They appeared to feel hungry less often and therefore eat less."

As for the follow-up, Heerspink says, "All signals are green to test this drug in a large study. I would like to find out whether it can lead to fewer dialyses or kidney transplants. And I would also very much like to investigate whether this drug also works positively in patients with kidney damage without obesity. It is only very difficult now to get enough of the drug to do the studies due to its unprecedented popularity."

Effect of Ozempic in type 2 diabetes

The class of drugs that Ozempic falls under is designed to treat type 2 diabetes. The drug affects the intestinal hormone GLP-1 which is responsible for proper processing of carbohydrates from food.

This is, in part, by stimulating insulin release by the pancreas. In addition, GLP-1 reduces the feeling of hunger and causes food to move more slowly from the stomach to the intestines. It gives a feeling of fullness for longer, leading to weight loss. These effects improve glucose control and weight loss.

More information: Semaglutide in patients with overweight or obesity and chronic kidney disease without diabetes: a randomized double-blind placebo-controlled clinical trial, Nature Medicine (2024). DOI: 10.1038/s41591-024-03327-6. www.nature.com/articles/s41591-024-03327-6

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