ROCHESTER, Minn. — Mayo Clinic researchers found that GLP-1 receptor agonists, medications widely used for diabetes and weight management, were associated with a lower risk of dialysis or kidney transplantation in adults with bipolar disorder and chronic kidney disease.

The study, published in the Journal of Clinical Psychiatry, suggests that a popular class of medications may offer an added benefit by helping protect kidney health in a high-risk group.

"People with bipolar disorder have a high burden of chronic kidney disease, but few strategies have been studied specifically to protect kidney health in this population," says Balwinder Singh, M.D., a Mayo Clinic psychiatrist and senior author of the study. "Our results are encouraging, but prospective studies are needed to determine whether GLP-1 medications directly slow kidney disease progression."

A high-risk population

Chronic kidney disease is an important concern in bipolar disorder because of higher rates of obesity, diabetes and high blood pressure, as well as the potential kidney effects of some psychiatric medications. Lithium, an important treatment for many patients, requires ongoing monitoring of kidney function.

GLP-1 receptor agonists were first developed to treat type 2 diabetes and are now also widely used for weight management. Some drugs in this class have been shown to protect kidney and heart health in people with diabetes and chronic kidney disease. Mayo Clinic researchers wanted to know whether similar kidney benefits might extend to people with bipolar disorder.

Researchers analyzed de-identified electronic health record data from TriNetX, an international research network that includes records from about 131 million adults across 117 health systems. They focused on adults with bipolar disorder and mild-to-moderate chronic kidney disease who had newly started a GLP-1 medication or a comparison treatment.

GLP-1 users were compared with patients taking either DPP-4 inhibitors, used to treat diabetes, or RAAS inhibitors, commonly used in chronic kidney disease. Researchers used statistical matching to make the groups more comparable and followed outcomes for up to five years.

Across both comparisons, GLP-1 use was associated with a lower risk of dialysis or kidney transplantation. The pattern was generally consistent across sex, race, obesity status and use of psychiatric medications, including lithium.

Implications for care

The findings may be especially relevant for patients whose psychiatric treatment requires careful monitoring of kidney function. They also point to opportunities for closer coordination among healthcare teams in psychiatry, nephrology, and primary care.

That approach aligns with Mayo Clinic's Genesis strategic initiative and its focus on preventing organ failure and preserving organ function. If confirmed in prospective studies and clinical trials, the findings could inform future strategies to slow kidney disease progression and reduce the risk of dialysis or transplantation.

"For patients with bipolar disorder, protecting kidney health often requires care across multiple specialties," Dr. Singh says. "If these findings are confirmed, they could help us develop better strategies to protect kidney function while continuing to effectively treat bipolar disorder."

Because the study was observational, it cannot establish that GLP-1 medications caused the lower risk. Researchers also could not fully account for medication dose, adherence, treatment duration or changes in therapy over time.

For a complete list of authors, disclosures, and funding, review the study.

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Media contact:

• Sharon Theimer, Mayo Clinic Communications, newsbureau@mayo.edu

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