Short answer: They can, mostly through dehydration. All four US labels warn about acute kidney injury, reported after approval and sometimes needing dialysis, mostly in people who lost fluids through nausea, vomiting or diarrhea. In the trials it was uncommon: 0.5% on Zepbound versus 0.2% on placebo. Separately, Ozempic is approved to lower the risk of kidney decline in adults with type 2 diabetes and chronic kidney disease, based on the FLOW trial.
Each label has a warning called "Acute Kidney Injury Due to Volume Depletion". Volume depletion means the body has lost too much fluid. The labels say there have been reports after approval of acute kidney injury, in some cases needing hemodialysis, and that most occurred in people who had stomach side effects that led to dehydration, such as nausea, vomiting or diarrhea.
The patient leaflets for Wegovy, Ozempic, Mounjaro and Zepbound put it this way: diarrhea, nausea and vomiting "may cause a loss of fluids (dehydration) which may cause kidney problems." They say it is important to drink fluids to help lower the chance of dehydration, and to tell your healthcare provider right away if nausea, vomiting or diarrhea does not go away.
For prescribers, the labels say to monitor kidney function in people reporting side effects that could lead to fluid loss. All four add "especially during dosage initiation and escalation", meaning the first weeks and each dose increase.
| Medicine and trials | On the medicine | Placebo |
|---|---|---|
| Wegovy, adults, weight reduction | 7 people (0.4 per 100 patient-years) | 4 people (0.2 per 100 patient-years) |
| Zepbound, weight reduction (Studies 1 and 2) | 0.5% | 0.2% |
| Ozempic and Mounjaro | No trial rate given; listed among reports after approval | n/a |
The Wegovy label says some of its cases happened along with stomach side effects or dehydration, and that 2 more people on Wegovy had acute kidney injury with dehydration in other trials. The Mounjaro and Zepbound labels list acute kidney failure or worsening of chronic kidney failure, sometimes needing hemodialysis, among reports after approval.
For people who already have reduced kidney function, the Ozempic, Mounjaro and Zepbound labels say no dose change is recommended, because kidney function did not change drug levels in a meaningful way. The Mounjaro label says to monitor kidney function when starting or raising the dose in people with kidney impairment who report severe stomach side effects. The Wegovy leaflet asks you to tell your provider before starting if you have or have had kidney problems.
The kidney picture has a second side. Ozempic is FDA approved to reduce the risk of sustained eGFR decline, end-stage kidney disease and cardiovascular death in adults with type 2 diabetes and chronic kidney disease. eGFR is the standard estimate of how well the kidneys filter blood.
That approval rests on FLOW, which randomly assigned 3,533 adults with type 2 diabetes and chronic kidney disease to semaglutide 1 mg weekly or placebo, on top of their usual kidney care. Over a median of 3.4 years, the main combined outcome (kidney failure, a 50% or greater drop in eGFR, or death from kidney or heart causes) happened to 331 people on semaglutide and 410 on placebo, a 24% lower risk. eGFR fell more slowly on semaglutide, by 1.16 units per year.
The Ozempic label says the way semaglutide lowers kidney risk has not been established, and that the benefit was not evident in people already taking SGLT2 inhibitor medicines, though there were few events in that group. FLOW studied people with both type 2 diabetes and kidney disease, so it does not show the same result for people without them.
MedlinePlus, the National Library of Medicine's health site, lists dehydration and some medicines, including NSAID pain relievers, among causes of acute kidney failure. Symptoms it lists include:
Several of these overlap with ordinary side effects. The labels themselves focus on stomach symptoms that will not go away. Noting how many days nausea, vomiting or diarrhea lasted, how much you managed to drink, and where you were in the dose schedule gives your provider what they need. Dose Track logs side effects next to each dose and keeps lab results such as eGFR in one place.
Read more on Dose Track: Nausea on GLP-1s: what the labels say · eGFR (glossary) · Ozempic side effects · Wegovy side effects · Mounjaro side effects · Zepbound side effects