Preoperative GLP-1 Receptor Agonists Exposure and Risk of Postoperative Acute Kidney Injury after Metabolic and Bariatric Surgery: A Retrospective Study

Dec 17, 2025Obesity surgery

Use of GLP-1 Medicines Before Weight-Loss Surgery and Risk of Kidney Problems After Surgery

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Abstract

Preoperative GLP-1 receptor agonist exposure was associated with a 1.6% risk of acute kidney injury within 90 days after metabolic and bariatric surgery.

Preoperative GLP-1 receptor agonist exposure was linked to a reduced risk of acute kidney injury compared to non-exposure (1.6% vs. 2.3%).
The hazard ratio for acute kidney injury at 90 days was 0.68, indicating a significant decrease in risk.
Preoperative GLP-1 receptor agonist exposure was also associated with a lower incidence of postoperative hyperglycemia (24.5% vs. 26.6%).
The hazard ratio for hyperglycemia was 0.91, suggesting a potential benefit in glycemic control during the perioperative period.
No significant differences were found in mortality, intensive care unit admission, or sepsis rates between the exposed and non-exposed groups.

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BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1-RAs) are increasingly prescribed for patients with type 2 diabetes mellitus (T2DM) and obesity undergoing metabolic and bariatric surgery (MBS). This study evaluated the association between preoperative GLP-1-RAs exposure and the risk of acute kidney injury (AKI) following MBS.

METHODS: This retrospective cohort study utilized the TriNetX Research Network to identify adults with T2DM and a body mass index exceeding 35 kg/m² who underwent elective laparoscopic MBS (2010-2024). Patients were stratified by preoperative GLP-1-RAs exposure and matched using propensity score analysis. The primary outcome was the incidence of AKI within 90 days after surgery, and the secondary outcomes included mortality, intensive care unit (ICU) admission, sepsis, and events of postoperative hyperglycemia (i.e., serum glucose > 180 mg/dL).

RESULTS: After propensity score matching, 5,480 patients were included in each cohort. Preoperative GLP-1-RAs exposure was associated with a significantly reduced 90-day AKI risk (1.6% versus 2.3%; hazard ratio [HR]: 0.68, 95% confidence interval [CI] 0.52-0.89, p = 0.005, absolute risk reduction [ARR]:0.73%, number needed to treat [NNT]:137) and 30-day risk (HR: 0.58, p = 0.001). GLP-1-RAs exposure also correlated with a lower risk of postoperative hyperglycemia (24.5% versus 26.6%, HR:0.91, 95% CI: 0.85-0.99, p = 0.013, ARR 2.04%, NNT 49). No significant differences were observed in mortality, ICU admission, or sepsis. Sensitivity analyses confirmed these consistent findings.

CONCLUSION: Preoperative GLP-1-RAs exposure was associated with a reduced AKI risk following MBS, with concurrent improvement in perioperative glycemic control. Future randomized controlled studies are required to validate these observational findings and clarify the underlying mechanisms.

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Preoperative GLP-1 Receptor Agonists Exposure and Risk of Postoperative Acute Kidney Injury after Metabolic and Bariatric Surgery: A Retrospective Study

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