Putting this up for argument rather than for agreement. I have read it twice and I am still not certain what it supports.
Two things drive this: people drink less because drinking makes them feel full, and they restrict salt at the same time as calories without noticing. The result reads as fatigue, headache, cramp and light-headedness on standing, all of which get blamed on the drug. Fluid plus sodium fixes most of it within a day, which is also how you can tell that is what it was.
Where I think it is weakest: the follow-up is short relative to how long people actually take these drugs, so durability is an assumption here rather than a finding.
The bit I cannot resolve on my own is why hydration goes wrong on this specifically, given that nobody is telling us to drink less. Happy to be told the question itself is wrong.
Dr.NateNeph said:Two things drive this: people drink less because drinking makes them feel full, and they restrict salt at the same time as calories without noticing.
Agreed, and the practical implication is not to over-read a single eGFR during a period of rapid loss and altered hydration. Trend, with UACR beside it.
Dr.NateNeph said:Two things drive this: people drink less because drinking makes them feel full, and they restrict salt at the same time as calories without noticing.
Muscle cramps on hydration — anyone else? I was getting severe leg cramps at night, especially calves. Bloodwork showed my magnesium was low.
GLP-1 agonists can cause electrolyte shifts due to reduced food intake and GI effects. Get your electrolytes checked and supplement accordingly. I take magnesium glycinate 400mg + potassium gluconate 99mg daily and cramps are gone.
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Browse GL BiochemTaking the question as asked, rather than the general version of it. FLOW is the relevant trial and it reported a meaningful reduction in kidney-disease progression and related death in people with type 2 diabetes and chronic kidney disease. The mechanism looks to be a mixture of reduced albuminuria, better glycaemia and blood pressure, and a probable direct anti-inflammatory effect on the glomerulus. Separately, eGFR is genuinely noisy during rapid weight loss — a small early dip is common and usually haemodynamic rather than damage.
Dr.RaviCardio said:Agreed, and the practical implication is not to over-read a single eGFR during a period of rapid loss and altered hydration.
Second this. Nothing to add that would improve it.