In this webinar, Balwinder Singh, MD, and Raman Baweja, MD, discuss the role of GLP-1 receptor agonists for long-term kidney protection in bipolar disorder. The presentation begins with the clinical context: lithium remains the gold standard mood stabilizer in bipolar disorder, but concern about chronic kidney disease may contribute to lower prescribing, even though bipolar disorder itself carries substantial cardiometabolic and renal risk.
The speakers then review why chronic kidney disease deserves attention in bipolar disorder, including high rates of obesity, diabetes, and cardiovascular disease, and they summarize kidney-related evidence for GLP-1 receptor agonists. They describe effects in the kidneys, including vasodilatation, action on the afferent and efferent arteriole, lower intraglomerular pressure, and reduced albuminuria, along with indirect effects through glycemic control, weight, insulin resistance, blood pressure, and cardiovascular protection. They also note published cases, case reports, and case series in which starting semaglutide or tirzepatide during lithium treatment was associated with higher lithium levels and toxicity, including one case that required dialysis.
The webinar next covers their real-world cohort analysis in adults aged 18 years and older with bipolar disorder and CKD stages 1, 2, or 3, using a new-user active-comparator design with DPP-4 inhibitors and RAAS inhibitors. The speakers describe propensity score matching, Cox proportional hazards models, Kaplan-Meier analyses, subgroup analyses, and negative controls. They report that GLP-1 receptor agonist use was associated with lower observed hazard of kidney replacement therapy versus both comparator groups, while healthcare utilization findings were less consistent after matching. They close by emphasizing that the findings are hypothesis generating rather than causal and by outlining a cautious lithium monitoring approach when a GLP-1 receptor agonist is started or stopped.
