Диетологи играют ключевую роль в управлении терапией GLP-1 для пациентов с болезнями почек

‘Hard work’: Dietitians’ role in GLP-1 therapy for patients with kidney disease Key takeaways: - Dietitians are positioned to help identify candidates for GLP-1 therapy and manage treatment. - Key concerns are clinical risk in appetite suppression, GI adverse effects and weight change interpretation. GLP-1 receptor agonists are becoming more widely used by patients with chronic kidney disease. Dietitians are positioned to contribute to the individualized care of these patients. Commentary from Kidney Disease: Improving Global Outcomes from May 2025 states that given the high prevalence of obesity among people with diabetes and CKD, incretin mimetic therapy offers the opportunity to improve glucose control, weight and clinical outcomes simultaneously. “The hard work is just beginning,” the KDIGO authors wrote. I completely agree. The work begins prior to the prescription and requires ongoing medical nutrition therapy management, education, symptom management and interdisciplinary team collaboration. A comprehensive, team-based care approach is key for safety, success and long-term sustainability of GLP-1 therapy for patients with CKD. Assessment, surveillance, support Even prior to GLP-1 drug initiation, dietitians are a partner positioned to help identify candidates for the therapy. We can assist with screening and assess patients to ensure nutrition status is adequate. Dietitians are attuned to patients who already are experiencing gastrointestinal (GI) symptoms, general frailty and inability to meet protein needs. It is after the prescription is filled that management of nutrition risk, tolerability and adherence begins. GLP-1 therapy introduces important considerations, including monitoring nutrition adequacy, supporting safety, assessing tolerability and helping with adherence. We know patients with CKD are at higher risk for poor nutrition-related outcomes. Contributing factors include uremia and renal diet restrictions in addition to patients’ comorbid conditions. Dietitians are focused on assessing individual nutrition status. This surveillance and support may influence adherence and attrition. Primary concerns for dietitians For the renal dietitian, the work is to address clinical risk in appetite suppression, GI adverse effects and weight change interpretation. Appetite suppression has the potential impact of protein-energy wasting. Even more emphasis is required on adequate protein due to the reduced intake and early satiety that comes with GLP-1 drugs. Educate and encourage a protein-first eating pattern by prioritizing protein foods at meals and, when appropriate, adding a high-protein nutrition supplement to complement the meal or snack. Compared with patients who have diabetes only, patients with CKD are at risk for protein-energy wasting, frailty and sarcopenia. GLP-1 medications suppress appetite and compound existing risks for inadequate protein and energy intake. Although monthly albumin levels are assessed, dietitians know they are only part of the picture as these levels are highly influenced by inflammation. GI issues of nausea, vomiting, constipation, reflux and diarrhea can occur for patients with CKD due to comorbid conditions, fluid restrictions and other medications. GLP-1 drugs can create more instability with GI issues and contribute to risks for fluid and electrolyte imbalance. Dietitians provide patient education around symptom management, offering suggestions for meal timing, slowing meal pacing, eating smaller, more frequent meals and identifying foods that may worsen GI effects, such as fatty foods or large meals. Educating the patient further with hydration guidance within fluid limits and adequate fiber intake are also key for symptom management. Weight change interpretation is important to manage for a patient prescribed GLP-1 therapy. For patients on dialysis, the key question is whether the weight change is true body mass loss, fluid loss or even both. The entire clinical team should be aware and ready to flag rapid unintended weight loss, signs of dehydration, unusual or abnormal lab trends and persistent vomiting for further discussion with the nephrologist to ensure fluid status is well managed. Adherence, attrition As concerns arise, dietitians may need to more closely monitor the nutrition of their patients on GLP-1 medications. Dietitians are positioned to assist with adherence and attrition by helping to identify and manage adverse effects early on, helping patients to set realistic expectations and keeping open dialogue for management of symptoms. Patient education tools have been developed by the National Kidney Foundation (https://www.kidney.org/news-stories/what-to-know-about-glp-1-medications-if-you-have-kidney-disease) and are an addition to the toolkit for clinicians caring for patients prescribed GLP-1 medications. For more information: Rebecca Brosch, RD, CSR, LD, is a Healio | Nephrology News & Issues Editorial Advisory Board Member and principal at RB Strategic Advisory, LLC. She can be reached at [email protected].