Understanding CKD and weight loss medications
Chronic kidney disease affects how our body processes medications, including Mounjaro.
Our kidneys typically filter waste products and excess fluid from our blood, but when they’re not functioning properly, medications can accumulate to potentially harmful levels.
CKD is classified into five stages based on our estimated glomerular filtration rate (eGFR), which measures how well our kidneys filter blood.
Understanding your CKD stage helps determine whether Mounjaro is appropriate for you.
Stage 1 (eGFR ≥90): Normal kidney function with some kidney damage – Mounjaro is typically safe with standard monitoring
Stage 2 (eGFR 60-89): Mildly decreased function – Usually safe with regular monitoring
Stage 3a (eGFR 45-59): Moderately decreased function – Requires closer monitoring, standard dosing often appropriate
Stage 3b (eGFR 30-44): Moderately to severely decreased function – Needs specialist input, may require dose adjustments
Stage 4 (eGFR 15-29): Severely decreased function – Requires nephrologist approval, careful monitoring essential
Stage 5 (eGFR <15): Kidney failure – Generally not recommended, specialist assessment required
Most people with CKD stages 1-3 can use Mounjaro safely with appropriate monitoring.
How Mounjaro affects kidney function
Unlike some medications that can directly damage kidneys, Mounjaro doesn’t appear to cause kidney harm in most people.
In fact, research suggests it may provide some kidney protection benefits.
A large study published in The Lancet found that people with type 2 diabetes taking tirzepatide had improved kidney function markers compared to those taking insulin.
The medication appeared to reduce the risk of kidney disease progression.
However, there are important considerations for people with existing CKD:
Dehydration risk: Mounjaro can cause nausea and reduced appetite, which may lead to dehydration. For individuals with chronic kidney disease (CKD), maintaining proper hydration is essential for maintaining kidney function.
Blood pressure effects: Weight loss from Mounjaro often improves blood pressure, which benefits kidney health. However, if you take blood pressure medications, your doses may need adjusting as you lose weight.
Blood sugar improvements: Better glucose control from Mounjaro can slow CKD progression, particularly for people with diabetic kidney disease.
Medication interactions: Some CKD medications may need dose adjustments as your weight and kidney function change.
Dosing adjustments for CKD
Most people with mild to moderate chronic kidney disease (CKD) can start Mounjaro at the standard dose of 2.5 mg weekly.
However, your doctor may recommend modifications based on your specific situation:
Stages 1-3 CKD: Standard dosing protocol typically appropriate, with more frequent monitoring than usual
Stage 4 CKD: May start at standard dose but with very close monitoring, particularly for dehydration and medication interactions
Stage 5 CKD: Generally avoided unless under specialist nephrologist care
The dose escalation schedule may be slower for people with CKD. While the standard protocol increases the dose every four weeks, your doctor might extend this to six or eight weeks to monitor how your kidneys respond.
Your prescribing clinician should coordinate with your nephrologist to ensure your CKD medications remain appropriate as your weight changes.
Blood pressure tablets, in particular, often need to be reduced as weight loss improves blood pressure control.
Essential monitoring requirements
Taking Mounjaro with CKD requires more frequent monitoring than for people with normal kidney function. Your healthcare team should track several key markers:
Kidney function tests: Your eGFR and creatinine levels should be checked every 3-4 months initially, rather than the usual 6-12 months for stable CKD.
Hydration status: Regular assessment for signs of dehydration, particularly during the first few months when nausea is most common.
Blood pressure monitoring: Weekly home blood pressure checks, as your medication needs may change with weight loss.
Electrolyte levels: Sodium, potassium, and other electrolytes should be monitored more frequently, particularly if you experience significant nausea or reduced appetite.
Medication review: Regular assessment of all your medications, as doses may need adjusting with weight loss and changing kidney function.
Cardiovascular risk factors: CKD increases heart disease risk, so lipid and diabetes markers need monitoring alongside kidney function.
Your GP should coordinate this monitoring with your specialist in kidney care.
Don’t attempt to manage this monitoring independently. The interaction between chronic kidney disease (CKD), weight loss, and multiple medications requires professional oversight.
NHS guidance and eligibility
NHS England guidelines for GLP-1 medications in people with chronic kidney disease (CKD) emphasise the importance of specialist input.
While Mounjaro isn’t specifically contraindicated for most people with CKD, accessing it through the NHS requires meeting specific criteria.
NHS eligibility for CKD patients:
- BMI ≥35 with weight-related health problems, or BMI ≥30 with type 2 diabetes
- CKD stage 3b or better (eGFR ≥30) in most areas
- Evidence of previous weight loss attempts
- No contraindications to treatment
- Willingness to engage with lifestyle support
Private prescription considerations:
If you don’t meet NHS criteria, private prescriptions are available. However, ensure your private prescriber:
- Reviews your complete CKD history
- Coordinates with your nephrologist
- Provides appropriate monitoring schedules
- Has experience with CKD patients
Many private providers won’t prescribe to people with stage 4-5 CKD due to the complexity of monitoring required.
Common concerns
Will Mounjaro make my kidney disease worse?
Current research suggests Mounjaro doesn’t worsen kidney function and may provide some protection. However, proper monitoring is essential to ensure your individual response is positive.
What if I become dehydrated from nausea?
Dehydration is the primary risk for patients with chronic kidney disease (CKD) who are taking Mounjaro.
Start with small, frequent sips of water, and contact your healthcare team if you can’t keep fluids down for more than 24 hours.
How will weight loss affect my other CKD medications?
Weight loss often improves blood pressure and blood sugar control, potentially requiring dose reductions in related medications. Your healthcare team should monitor and adjust these proactively.
Can I take Mounjaro if I’m on dialysis?
This requires a specialist nephrologist assessment. Some people on dialysis can use Mounjaro, but the monitoring requirements are complex, and not all providers will feel comfortable prescribing it.
What about kidney transplant recipients?
People with kidney transplants require specialist input from an immunosuppression specialist before starting any new medication, including Mounjaro. The interaction with anti-rejection medications requires careful consideration.
Why Second Nature doesn’t currently accept CKD patients
At Second Nature, we don’t currently accept individuals living with chronic kidney disease (CKD) into our Mounjaro programme.
This isn’t because the medication is unsafe for CKD patients; it’s because the level of medical monitoring required exceeds what we can provide through our current programme structure.
People with CKD need:
- More frequent kidney function monitoring
- Coordination with nephrology services
- Complex medication interaction management
- Specialist oversight for dose adjustments
Our programme is designed for people who can safely use Mounjaro with standard monitoring protocols.
For patients living with CKD, the safest approach is management through NHS services or private providers with specialised expertise in CKD.
This may change as our medical capabilities expand, but currently, we prioritise patient safety by ensuring appropriate specialist oversight for complex medical conditions.
Take home message
You can take Mounjaro if you have chronic kidney disease, but only with proper medical supervision and coordination between your healthcare providers.
People with mild to moderate CKD (stages 1-3) can often use Mounjaro safely with appropriate monitoring, while those with more advanced disease need specialist assessment.
You must ensure your GP, nephrologist, and prescribing clinician work together to monitor your kidney function, adjust other medications as needed, and watch for signs of dehydration or other complications.
If you have CKD and want to explore Mounjaro, speak to your GP about referral to an appropriate service that can provide the specialist monitoring you need.
Don’t attempt to access the medication without proper medical oversight; the complexity of managing CKD alongside weight loss medication requires professional coordination.
While we can’t currently accept CKD patients into our programme, we believe everyone deserves access to safe, effective weight loss treatment with appropriate medical support.
Second Nature's Mounjaro programme
Second Nature provides Mounjaro as part of our Mounjaro weight-loss programme
Why choose Second Nature over other medication providers, assuming you’re eligible?
Because peace of mind matters.
We’ve had the privilege of working with the NHS for over eight years, helping people across the UK take meaningful steps toward a healthier, happier life.
Our programmes are designed to meet people where they are, whether that means support with weight loss through compassionate one-to-one health coaching, or access to the latest weight-loss medications (like Mounjaro) delivered alongside expert care from a multidisciplinary team of doctors, psychologists, dietitians, and personal trainers.
At the heart of everything we do is a simple belief: real, lasting change comes from building better habits, not relying on quick fixes. We’re here to support that change every step of the way.
With over a decade of experience, thousands of lives changed, and a long-standing record of delivering programmes used by the NHS, we believe we're the UK’s most trusted weight-loss programme.
We hope to offer you something invaluable: peace of mind, and the support you need to take that first step.
