People receiving dialysis remain at high risk for cardiovascular events and death, although evidence guiding glucagon-like peptide-1 receptor agonist use after dialysis initiation remains limited. A post hoc analysis published in Diabetes Care evaluated safety outcomes among participants who initiated dialysis during treatment in four randomized semaglutide trials.
The analysis pooled data from SUSTAIN-6, SELECT, FLOW, and SOUL. Across the four studies, 34,064 participants were randomized, including 307 who initiated dialysis during follow-up. Of these, 165 participants originally assigned to semaglutide (n = 71) or placebo (n = 94) remained on treatment after dialysis initiation.
Findings
- Serious adverse events (SAEs) occurred in 32 of 71 participants (45%) receiving semaglutide and 54 of 94 participants (57%) receiving placebo after dialysis initiation.
- Permanent treatment discontinuation occurred in 8.5% of the semaglutide group and 10.6% of the placebo group.
- MACE rates were 9.7 and 16.1 events per 100 person-years in the semaglutide and placebo groups, respectively.
- All-cause mortality rates were 13.8 and 18.1 events per 100 person-years in the semaglutide and placebo groups, respectively.
Continuation of semaglutide after dialysis initiation appeared safe in this post hoc analysis, although additional studies are needed to evaluate effects on cardiovascular outcomes and mortality.
