Semaglutide in adults receiving dialysis: anthropometric outcomes and transplant-access milestones in a systematic review with exploratory meta‑analysis

Abstract Background Obesity can delay access to kidney transplantation in patients receiving dialysis, but evidence for semaglutide in this setting remains limited. We evaluated anthropometric, safety and transplant-access outcomes in adults receiving dialysis. Methods We searched PubMed, Embase, the Cochrane Library/CENTRAL, ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform from inception to 23 May 2026. Eligible reports evaluated semaglutide in adults receiving dialysis; mixed populations without separately extractable dialysis-specific outcomes were retained only for supportive or descriptive analyses. Mean within-cohort changes in body weight and body mass index (BMI) were pooled with random-effects models when change-score standard deviations were directly reported. Comparative estimates, transplant-access milestones and safety outcomes were synthesised separately. Results Twenty reports were included in the evidence map; seven main studies comprised 147 semaglutide-exposed participants. Four studies (89 participants) contributed to an exploratory weighted descriptive synthesis of within-cohort body-weight change, with a weighted mean change of − 7.25 kg (95% confidence interval − 10.70 to − 3.80; I² = 87%). Three studies (65 participants) contributed to the corresponding exploratory BMI synthesis, with a weighted mean change of − 2.79 kg/m² (95% confidence interval − 4.31 to − 1.27; I² = 92%). In selected transplant-candidate cohorts, waitlist activation or listing occurred in 14/29 and 13/23 previously ineligible patients; 7/29 and 8/23 were subsequently transplanted. A third cohort reported 3/41 transplants. In the early-terminated RAISE-KT registry result from a mixed advanced-CKD/dialysis population, new activation occurred in 3/5 semaglutide-treated participants versus 0/7 placebo. Gastrointestinal adverse events were reported in 59/146 participants and adverse-event-related discontinuation in 21/147. Conclusions Across dialysis cohorts, body weight and BMI decreased during follow-up after semaglutide initiation, but the evidence base was small, heterogeneous and predominantly uncontrolled. Transplant-access events were observed in selected candidates, but causal effects on listing or transplantation cannot be established. Comparative prospective studies with standardised anthropometric, transplant-access and dialysis-specific safety outcomes are needed.