GLP-1 receptor agonists such as Ozempic and Wegovy, widely used for diabetes treatment and weight management, have been found to potentially reduce the risk of certain patients requiring major kidney treatment.
Researchers at the Mayo Clinic found that the medications were associated with a lower risk of dialysis and kidney transplantation among those with bipolar disorder, a mental health condition, and chronic kidney disease.
The finding is notable given that individuals with bipolar disorder face higher rates of chronic kidney disease and premature mortality than those without the condition, and the researchers say they remain "underrepresented" in related trials. The study was published in the Journal of Affective Disorders.
Bipolar disorder affects a person’s mood, energy, activity and thought, and is characterized by manic and depressive episodes, where mood can swing from one extreme to another, as well as a huge range of other symptoms. It has been estimated that around 4.4 percent of U.S. adults will experience the condition at some point in their lives.
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Why Chronic Kidney Disease Rates Are Higher Among Those With Bipolar Disorder
Rates of chronic kidney disease are higher among those with bipolar disorder, and one theory behind the association points towards long-term lithium use.
Lithium is an effective mood stabilizer, and is used as a drug therapy to prevent bipolar disorder relapse. However, studies have found that long-term use of the drug may be behind significantly higher declines in estimated glomerular filtration rate (eGFR), a blood marker used to determine how well a person's kidneys are functioning.
"Although it remains the most effective long-term mood stabilizer we have, over years it can injure the kidney," Dr Jai Radhakrishnan, a professor of medicine at Columbia University, told Newsweek, adding that in some patients it may cause kidney scarring. "Unless practitioners monitor lithium levels and kidney function closely, this kidney injury can progress to kidney failure," he said.
Dr Jordy Cohen, an assistant professor of medicine and epidemiology at the University of Pennsylvania, told Newsweek that other theories are also under investigation and it is likely down to a "combination of factors, including exposure to medications to treat their bipolar disorder that directly increase the risk for kidney disease (like lithium) or that indirectly increase the risk for kidney disease, by increasing the development of metabolic risk factors such as obesity and diabetes."
She also said that people with bipolar disorder are also "at risk for socioeconomic disadvantage, a major risk factor for kidney disease."
"There is also some research suggesting their elevated risk may be due to increased underlying inflammation and oxidative stress," she said.
How GLP-1s Could Affect Kidney Health
The researchers analyzed data from TriNetX, an international research network that has records from around 131 million adults in 117 health systems. They found that across a sample of around 1.5 million adults with bipolar disorder, around 96,000 also had chronic kidney disease.
Among those with bipolar disorder and mild-to-moderate kidney disease, they logged which participants had recently started taking a GLP-1 medication, DPP-4 inhibitors (which are used to treat diabetes), or RAAS inhibitors (which are commonly prescribed for chronic kidney disease).
After following the participants for five years, the researchers found that the group with both conditions, who were also taking GLP-1 medication, were less likely to have had dialysis—a medical procedure used to remove waste products from the body when the kidneys are not working as they should—or kidney transplantation.
They found a 44 percent relative reduction, although while this sounds "dramatic," Radhakrishnan said the difference was about 3 to 5 percentage points over five years.
He also noted that, because the main comparison drug was a diabetes medication, "these results mostly apply to people with diabetes. A randomized trial in people with mental illness would be the gold standard."
The researchers said this pattern was found to be consistent across several factors including sex, race, obesity status, and use of medications like lithium.
There could be a number of reasons for this association, one being that GLP-1 medication helps people to "reduce weight and control diabetes, which are both major risk factors for new and worsening kidney disease," Cohen said.
She explained that extra weight "puts stress on the kidneys for many reasons, including increased blood flow to the kidneys that causes mechanical stress and increased activation of several biological pathways that can be toxic to the kidneys, including aldosterone (which controls salt and water), the sympathetic nervous system (responsible for our fight or flight response), and inflammation."
She added that diabetes is "one of the top risk factors for kidney disease worldwide," and said that GLP-1 medication can "indirectly improve kidney health by reducing excess weight and improving diabetes control."
What The Findings Mean
Radhakrishnan said that "we now have a package of therapies to slow down kidney disease progression," which includes GLP-1 receptor agonists, however, he said that there is "not a 'one size fits all' approach," and that the "practical message is to match the drug to the patient, and many patients will benefit from combination therapy."
He also said that "safety is an important consideration," as GLP-1 drugs commonly cause nausea, vomiting and reduced food and fluid intake.
"In someone on lithium, they may experience dehydration which can push lithium levels into the toxic range, and Mayo’s own group has reported cases of lithium toxicity after starting semaglutide," he said. He also said that this "is an observational study of health records, not a randomized trial."
As people with bipolar disorder are known to have an elevated risk of developing kidney disease than the general population, Cohen said that "we need more information on how best to target therapy for them to reduce their risk."
She said that this study is "exploratory and does not really demonstrate very definitive findings," but that it "emphasizes the need for more research in this space to help us with identifying the best ways to prevent kidney disease and reduce the risk for kidney disease progression among people who are at the highest risk."
Reference
Balwinder Singh, Feyza Yaylaci, Hossam M. Ali, Ritika Baweja, Maria L. Gonzalez Suarez, Raman Baweja, (2026)
SGLT2 inhibitors versus GLP-1 receptor agonists and risk of kidney replacement therapy and healthcare utilization in bipolar disorder with chronic kidney disease: An active-comparator, new-user cohort study. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2026.122407
Contact Newsweek editor on this story: Edward Pearcey.