Abstract: TH-PO0372
GLP-1 Receptor Agonists and Serious Adverse Events of Hyperkalemia/Hypokalemia: Systematic Review and Meta-Analysis
Session Information
- Diabetic Kidney Disease: From Early Biomarkers to Novel Therapeutic Targets
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 702 Diabetic Kidney Disease: Clinical
Authors
- Shah, Samveg, University of Toronto, Toronto, Ontario, Canada
- Faruque, Labib, University of Toronto, Toronto, Ontario, Canada
- Zhaksylyk, Kuralay, University of Toronto, Toronto, Ontario, Canada
- Brown, Tyler D., University of Toronto, Toronto, Ontario, Canada
- Odutayo, Ayodele, University of Toronto, Toronto, Ontario, Canada
Background
Hyperkalemia is a risk factor for cardiovascular disease and death and is a common side effect of kidney and cardiovascular protective medications. Small physiological studies and observational studies suggest that glucagon like peptide-1 receptor agonists (GLP1RAs) may have kaliuretic properties. The objective of this study to determine the effect of GLP1RAs on the risk of serious adverse events (SAEs) of hyperkalemia and hypokalemia.
Methods
We completed a systematic review and meta-analysis via a PubMed Search Strategy. We selected for randomized controlled trials (RCT) enrolling at least 500 participants with 52 weeks of follow-up following adults with and without diabetes participating in RCTs of GLP1RAs versus placebo, irrespective of the primary outcome of the study. If available, we extracted the serious adverse event (SAE) data of hyperkalemia and/or hypokalemia available on clinicaltrials.gov.
Results
We included 11 RCTs. The median incidence of SAEs of hyperkalemia in the placebo group was 0.13%. GLP1RAs reduced the incidence of SAEs of hyperkalemia by 31% (RR 0.69, 95% CI 0.49-0.99) with no evidence of heterogeneity (I2=0%). GLP1RAs did not increase in the incidence of SAEs of hypokalemia (HR: 1.08, 95% CI: 0.71-1.65) with no evidence of heterogeneity (I2=0%).
Conclusion
GLP1RAs reduce the incidence of SAEs of hyperkalemia without increasing the risk of SAEs of hypokalemia. GLP1RAs may therefore prevent severe hyperkalemia when combined with other kidney and cardioprotective medications.
GLP1RA is glucagon like peptide-1 receptor agonist. Displayed is a forest plot of individual relative risks and 95% confidence intervals. The size of the box represents the weight of the individual study. The diamond is the weighted summary estimate.