Renal effects and safety of tirzepatide in subjects with and without diabetes: A systematic review and meta-analysis.

Summary

Across 15 RCTs, tirzepatide reduced UACR without harming eGFR in people with T2D and in those with obesity without diabetes, indicating potential renal benefit and reassuring safety in the short term.

Key Findings

• Meta-analysis of RCTs indicates tirzepatide reduces UACR compared with control conditions.
• No detrimental effect on eGFR was observed in short-term RCTs across T2D and obesity populations.
• Overall renal safety profile was reassuring; longer-term, hard renal outcomes remain to be established.

Clinical Implications

Clinicians can anticipate albuminuria improvements with tirzepatide without short-term eGFR penalty; monitoring UACR may aid risk stratification, while awaiting longer-term renal outcome data.

Limitations

• Short follow-up horizons preclude conclusions on hard renal endpoints (e.g., sustained eGFR decline, ESKD)
• Heterogeneity of comparators and trial populations; individual patient data were not analyzed

Future Directions

Conduct long-duration, dedicated renal outcome trials of tirzepatide and IPD meta-analyses to define effects on eGFR slope, CKD progression, and albuminuria regression.