A Mayo Clinic observational study published in the Journal of Clinical Psychiatry found that GLP-1 receptor agonists are associated with a reduced risk of dialysis or kidney transplantation in adults with bipolar disorder and chronic kidney disease. Concurrently, a UTHealth study of over two million surgery records linked GLP-1 use to an 11 percent reduction in major cardiovascular events and an 8 percent drop in postoperative infections. Researchers emphasize observational designs cannot prove causality.
Mayo Clinic bipolar study findings
- ▪The reduced risk of dialysis or kidney transplantation associated with GLP-1 receptor agonists in patients with bipolar disorder and chronic kidney disease was consistent across sex, race, obesity status, and lithium use.
- ▪Mayo Clinic researchers analyzed electronic health record data from TriNetX, covering approximately 131 million adults across 117 health systems, to evaluate GLP-1 receptor agonists in patients with bipolar disorder.
- ▪A Mayo Clinic study published in the Journal of Clinical Psychiatry found GLP-1 receptor agonists were associated with a lower risk of dialysis or kidney transplantation in adults with bipolar disorder and chronic kidney disease.
Kidney risks in bipolar disorder
- ▪Adults with bipolar disorder face a high burden of chronic kidney disease driven by elevated rates of obesity, diabetes, high blood pressure, and potential kidney impacts from psychiatric medications such as lithium.
- ▪Lithium, a key psychiatric medication for treating bipolar disorder, requires ongoing monitoring of kidney function due to potential long-term impacts on kidney health.
UTHealth elective surgery study findings
- ▪GLP-1 receptor agonist use before elective surgery between January 2016 and December 2024 was associated with 8 percent lower postoperative infection odds (4.9 percent vs 5.3 percent), including surgical site, urinary tract, pneumonia, and sepsis.
- ▪Lead author Josephine Tolan stated GLP-1 receptor agonists may modulate inflammatory pathways beyond appetite suppression, potentially mitigating inflammatory responses triggered during elective surgery.
- ▪In a study of 2,028,601 elective surgery adults (including 145,610 GLP-1 users) between January 2016 and December 2024, GLP-1 receptor agonist use was linked to an 11 percent reduction in major cardiovascular complications (1 percent vs 1.1 percent).
Preoperative management and clinical guidance
- ▪Lead author Josephine Tolan stated current United States guidance favors individualized decisions regarding preoperative GLP-1 receptor agonist management rather than routinely withholding the medications before surgery.
- ▪Anesthesiologists express concern that GLP-1 receptor agonists delay gastric emptying, potentially leaving residual stomach contents and increasing aspiration risks during anesthesia despite standard preoperative fasting.
- ▪Obesity physician Dr. Jessica Duncan stated that patients should inform surgical and anesthesia teams of their GLP-1 medication type, dosage, and last dose date rather than altering medication without medical guidance.
Need for further research and clinical interpretation
- ▪Dr. Jessica Duncan stated that findings may support individualized preoperative GLP-1 decisions for doctors, but do not justify starting the drugs specifically to prevent surgical complications.
- ▪Lead author Josephine Tolan stated that further research is needed to establish whether preoperative GLP-1 receptor agonist benefits are causal and how best to balance them against aspiration risks.
Study limitations and observational constraints
- ▪Mayo Clinic researchers and UTHealth researchers cautioned that their respective studies were observational and cannot establish that GLP-1 receptor agonists directly caused the observed risk reductions.
- ▪The Mayo Clinic observational study could not fully account for GLP-1 medication dosage, patient adherence, treatment duration, or changes in therapy over time among bipolar disorder patients.
- ▪Dr. Jessica Duncan noted the UTHealth surgery study focused on inpatient procedures without reporting aspiration outcomes, and did not establish whether or when patients stopped taking GLP-1 drugs before surgery.
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