Table 1.
Current GLP-1 receptor agonists and recommendations in patients with renal impairment.
| Agent | Dose | Half-life (h) | Elimination | Recommendations in patients with renal impairment |
||
|---|---|---|---|---|---|---|
| Mild | Moderate | Severe or ESKD | ||||
| Short-acting GLP-1 receptor agonists | ||||||
| Exenatide | 5–10 μg BID | 2.4 | Mainly renal | No adjustment | Conservative dose escalation | Not recommended |
| Lixisenatide | 10–20 μg QD | 3.0 | Mainly renal | No adjustment | No adjustment | Not recommended |
| Long-acting GLP-1 receptor agonists | ||||||
| Exenatide | 2 mg QW | N/A | Mainly renal | No adjustment | Not recommended | Not recommended |
| Liraglutide | 0.6 mg, 1.2 mg or 1.8 mg QD | 11.6–13.0 | Peptidases, renal and feces | No adjustment | No adjustment | Not recommended eGFR <15 ml/min |
| Albiglutide | 30–50 mg QW | ~120.0 | Peptidases and renal | No adjustment | No adjustment | Not recommended |
| Dulaglutide | 0.75–1.5 mg QW | ~112.8 | Peptidases and renal | No adjustment | No adjustment | Not recommended |
| Semaglutide | 0.5–1.0 mg QW | 165.0–184.0 | Peptidases and renal | Unknown | Unknown | Unknown |
Adapted from Muskiet et al.5
Mild renal impairment indicates creatinine clearance of 50/60–89 ml/min; moderate 30–50/60 ml/min; severe <30 ml/min or ESKD.
BID, twice daily, eGFR, estimated glomerular filtration rate; ESKD, end-stage kidney disease, GLP-1, glucagon-like peptide 1; N/A, not available; QD, once daily; QW, once weekly.