i’ve been considering adding tirzepatide to my ckd treatment, anyone else with adpkd tried it? my eGFR is mid 50s, wondering if it’s worth the shot, esp with potential benefits for kidney function
the optimism isn’t unfounded, the SURPASS-4 trial had encouraging secondary kidney outcomes. So I get where the question comes from. My gentle pushback would be on the risk during titration.
The GI side effects can be significant, and dehydration is a known trigger for acute kidney injury. With an eGFR in the mid 50s, your buffer for a dehydration event is just a lot smaller than it is for someone with normal kidney function. It’s a major confound that changes the risk/reward math.
This feels like a conversation that has to be run through your nephrologist, not just a PCP or endo. They’re the only ones who can properly weigh the potential long-term benefits against your specific short-term AKI risk. 💪
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the “potential benefits for kidney function” question is the right one to be asking, especially given the recent trial data. the big study everyone is talking about is the FLOW trial. it’s important to be precise here, though: that trial was for semaglutide, not tirzepatide. it showed a 24% lower risk of major kidney events in people with type 2 diabetes and ckd.
that’s a significant signal. for tirzepatide specifically, the data is still emerging. the SURPASS-4 trial had pre-specified kidney outcomes as secondary endpoints and showed some positive signs, like a slower rate of eGFR decline compared to insulin glargine. but that’s different from a dedicated, primary-endpoint renal outcomes trial like FLOW.
a tirzepatide trial called TREASURE-CKD is ongoing, so we’ll have more direct data eventually. the other piece to flag is that most of this research is in diabetic kidney disease. you mentioned ADPKD, which has a different underlying mechanism. so extrapolating from the t2d trial population to adpkd is a step you’d have to take carefully with your nephrologist.
the mechanism of benefit might not transfer cleanly.
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hmm aDPKD is complicated, ask your renal team 😂
that question about “potential benefits for kidney function” with tirzepatide is a critical one. for me, getting my fasting insulin from 22 down to single digits was about protecting my whole system from chronic hyperinsulin
hmm this is a really important conversation to have with your nephrologist, not just a GP. The main question I would bring to them is how the recent kidney outcome data from the major GLP-1 trials, which largely focused on diabetic kidney disease, is being applied to patients with ADPKD.
The key variable here is ADPKD vs diabetic nephropathy. Most of the positive kidney data for GLP-1s, including for tirzepatide in trials like SURPASS-4, comes from T2D populations.
How that evidence applies to a different underlying cause of CKD is the exact question for your nephrologist. They’re the only one who can really map the trial data onto your specific situation.
If you go this route, tracking your eGFR trend against your dose will be the most important signal you have. I use the journal field in CareClinic to log all my labs for exactly this reason, so I can pull up the trend line with my endo at every visit.
Definitely a nephrologist question, not a GP one. The big data point to bring up is the FLOW trial.
It was with semaglutide, not tirzepatide, but it showed a 24% lower risk of major kidney events for patients with T2D and CKD. That’s the signal everyone is looking at.
The main question I’d ask my doc, with an eGFR in the 50s, is how they plan to manage the dehydration risk. The early side effects can make
eGFR in the mid 50s is definitely a conversation for your nephrologist. while tirzepatide has shown some renoprotective effects in T2D patients, separating the drug’s direct impact from the metabolic load coming off requires a different study design than most of what’s out there. most of those “potential benefits” are tied to better glucose management or weight loss, which might not be the primary mechanism for ADPKD.
the “potential benefits for kidney function” question is the right one to be asking, especially given the recent trial data. the big study everyone points to for tirzepatide is SURPASS-4, which looked at T2D patients with high cardiovascular risk.
they found that tirzepatide significantly slowed the rate of eGFR decline compared to insulin glargine. so
ADPKD physiology is pretty distinct from diabetic nephropathy.
insulin resistance matters here