Offering a promising approach to weight management when used with diet and physical activity, evidence is also growing for the use of GLP-1 medications for kidney patients, although more research is needed.
We spoke to Rochelle Blacklock, Clinical Lead Dietitian (Kidney and Bariatric Surgery), King’s College NHS Foundation Trust and Dr Adrian Brown, NIHR Advanced Fellow & Senior Specialist Weight Management Dietitian, University College London, for information about the use of GLP-1 medication to aid weight loss in people living with kidney disease and obesity.
Many thanks also to Dr Graham Lipkin, Consultant Nephrologist at Queen Elizabeth Hospital Birmingham and Chair of Trustees at Kidney Care UK.
What are GLP-1 medications?
GLP-1 medications, also called GLP-1 receptor agonists (GLP-1 RA), are medications approved for the management of type 2 diabetes and/or obesity, alongside diet and physical activity. They mimic the effects of the body’s natural hormone – glucagon-like peptide-1 (GLP-1) – which is released from the gut when we eat to help us feel full.
GLP-1 medications were initially approved for managing type 2 diabetes, as they help control blood sugar. They contribute to weight loss by reducing appetite, increasing the feeling of fullness and delaying gastric (stomach) emptying, which helps to reduce food intake.
Clinical studies have shown significant weight loss may be achieved with these medications, although the amount of weight lost can vary depending on the medication, dose and individual. When they are prescribed GLP-1 medication, people need access to wraparound support, including dietetic advice, physical activity guidance and behavioural change support.
Currently, GLP-1 medications used for obesity management are given by injection. The dose prescribed for weight loss is typically higher than the dose prescribed for diabetes management.
Which GLP-1 medications are approved for weight loss?
In England, the National Institute of Health and Care Excellence (NICE) has approved three GLP-1 class medications for weight management in adults, to be used alongside a reduced calorie diet and increased physical activity:
- Liraglutide
- Semaglutide
- Tirzepatide
The two most recently approved are semaglutide (available as Wegovy®) and tirzepatide (available as Mounjaro®/Zepbound®).
Tirzepatide is a combined GLP-1 and GIP (glucose-dependent insulinotropic peptide) receptor agonist. Including these medications in NHS weight management pathways requires new services and training for healthcare professionals.
To manage demand in the NHS, there will be a phased introduction for delivering GLP-1 medications to eligible groups, based on clinical need. Other medical conditions are taken into account, as well as body mass index (BMI). For eligible patients, access may be through a specialist weight management service or local GP surgeries (primary care).
Work is underway to support the roll out of these medications, and it will be important for kidney teams to be involved. To find out if you are eligible to be assessed to see if the treatment would be suitable for you, speak to your kidney team, if you have one, or check with your GP.
Please be aware that it may take time to have these conversations. Due to the significant media coverage on these treatments, the health service in your area is likely to be receiving a lot of calls from people wanting to access them.
It may be that your doctor or kidney team will ask you to not contact them in the first instance and instead refer you to another part of the local health service so that they can manage demand. If you see your GP or kidney doctor frequently or on a regular basis you may wish to ask them about these treatments at your next planned appointment.
Which medications are approved for weight loss in the other nations of the UK?
In Wales, weight management medication is only prescribed within a specialist service, and only in combination with lifestyle intervention.
In Scotland, liraglutide (Saxenda®), semaglutide (Wegovy®) and tirzepatide (Mounjaro®) are approved for NHS restricted use for weight management.
In Northern Ireland, a new Regional Obesity Management Service will open in 2026 and offer patients access to weight loss medication in line with NICE guidance; at present, limited services are available.
Some people may be prescribed GLP-1 medication for type 2 diabetes management, but different eligibility criteria will apply.
GLP-1 medications: possible side effects
Before prescribing a GLP-1 medication, healthcare professionals should consider if the medication is suitable and talk through its benefits and limitations, including possible side effects.
GLP-1 medications are not recommended for people with certain health conditions/family histories, for pregnant women/those planning to get pregnant, or those who are breastfeeding. For people with CKD, the stage of kidney function can influence the prescribing of a GLP-1 medication.
As with all medications, there are potential side effects and risks associated. The most common GLP-1 medicine side effects are gastrointestinal, including nausea, vomiting, diarrhoea, constipation and stomach pain.
More serious, but less common, risks include pancreatitis (inflammation of the pancreas) and gallbladder disorders. GLP-1 medications can also increase the risk of hypoglycaemia (low blood sugar levels), so people living with diabetes should seek advice from their healthcare team to help manage this additional risk.
GLP-1 and CKD safety considerations
Some studies have found people living with CKD, particularly those in advanced stages or kidney failure, are more likely to experience gastrointestinal side effects from GLP-1s. For people living with CKD, nausea, vomiting and diarrhoea can cause dehydration, which may cause kidney problems to worsen.
"Some of the side effects of GLP-1 medicines include dehydration, which can result in acute kidney injury (AKI). We have seen this happen, and this can be particularly problematic if your kidney function is already lower due to CKD," says Dr Lipkin.
People with CKD should be given advice on how to prevent dehydration, and additional monitoring of kidney function may be needed when starting, or increasing, doses of GLP-1 medications.
Another consideration is that we do not know about the impact on your kidneys once you stop taking these medications. There are reports of increased weight gain once patients stop taking them, but what we don’t know is whether they may also contribute to a decrease in kidney function when the injections are no longer being administered.Dr Graham Lipkin
Could GLP-1 medications affect other medications I am taking?
Oral contraception
"There have also been concerns raised about the impact of GLP-1s on the effectiveness of oral contraception, likely to be caused by side effects of vomiting and diarrhoea," explains Dr Lipkin. "Unplanned pregnancy in women with CKD can have a significant impact on kidney function and the safety of GLP-1s at conception or in pregnancy is unknown."
Tacolimus/ciclosporin
“So far, there is no evidence that GLP-1s interact with critical medication taken by people with kidney disease, but as with the introduction of any new medication, those who take tacrolimus/ciclosporin should have their levels checked."
Kidney disease and GLP-1 medications
Growing evidence suggests GLP-1 medications may be beneficial for people living with CKD and obesity. This is because obesity impacts both the development and progression of kidney disease and can be a barrier to kidney care.
Evidence also suggests GLP-1 medication may play a role in reducing the risk of kidney disease worsening and cardiovascular disease, with further studies underway.
However, existing studies are limited and have not included large numbers of people with CKD, particularly those with advanced CKD, kidney failure or post kidney transplantation. So, questions remain, including:
- which groups of people with CKD are best suited for GLP-1 medications
- the medication's impact on body composition (fat and muscle mass), which is important as people with CKD can be at risk of muscle loss
- medication tolerance
- effectiveness of inducing and maintaining weight loss in people with CKD
- if outcomes from real-world patient experiences are similar to those seen in research studies
Some of these questions will be addressed in ongoing or planned studies, and with more experience of these medications in clinical practice.
Private prescriptions of GLP-1 medications
GLP-1s are prescription-only medicines and should only be prescribed by a registered healthcare professional. In June 2024, the World Health Organisation (WHO) issued a warning over fake versions of semaglutide which were identified in the UK.
You should always obtain prescription medicines from a qualified healthcare provider as the use of falsified products could lead to serious health consequences.
In summary, if you wish to learn more about these medications, it’s important that you do your research and understand if you meet the NHS eligibility criteria. While some people have been accessing GLP-1s privately, it’s important to note that weight-loss medications should be prescribed, and any medical review taken must be completed honestly and in full. With these medications gaining popularity, people who are vulnerable because they are desperate to lose weight may be taken advantage of by fake sellers. As with all new medications, you must discuss this openly and honestly with your kidney doctor – if you have one – or your GP, before making any changes to the medication you take.Dr Graham Lipkin
More information about GLP-1 medications and CKD
This page will be updated regularly as new information becomes available.
Last updated 2 July 2025