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KDIGO 2022 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease

The most frequent gastrointestinal side effects include: Nausea and vomiting : Very common, typically most pronounced during dose escalation Diarrhoea : Common to very common, though usually mild to moderate Constipation : Can occur due to delayed gastric emptying and reduced gut motility Abdominal pain and discomfort : Common Dyspepsia and gastro-oesophageal reflux : May worsen in susceptible individuals Other important adverse effects include: Gallbladder disorders : Cholelithiasis and cholecystitis have been reported, particularly with weight loss Dehydration and acute kidney injury : May occur secondary to severe gastrointestinal symptoms Hypoglycaemia : Risk increases when used with insulin or sulfonylureas, which may require dose adjustment Current limited evidence does not suggest an increased risk of inflammatory bowel disease (IBD) flares with GLP-1 agonists, though more data are needed

If IGF-1 does not rise after 12 weeks of adequate dosing, pituitary insufficiency may be the cause, and direct GH replacement becomes the only effective option

This comprises 2 approaches