Semaglutide and Kidney Outcomes in Patients with Type 2 Diabetes and Chronic Kidney Disease
In the FLOW trial, once-weekly semaglutide reduced the risk of major kidney disease events and death from cardiovascular causes by roughly a quarter in patients with type 2 diabetes and chronic kidney disease.
Background
Patients with type 2 diabetes and chronic kidney disease are at high risk for kidney failure, cardiovascular events, and death. Whether the GLP-1 receptor agonist semaglutide could mitigate these risks had not been established prior to this dedicated kidney outcomes trial.
Study design
FLOW randomized 3533 patients with type 2 diabetes and chronic kidney disease (eGFR 50 to 75 ml/min/1.73 m2 with UACR over 300 to under 5000, or eGFR 25 to under 50 with UACR over 100 to under 5000) to subcutaneous semaglutide 1.0 mg weekly or placebo. The primary outcome was a composite of kidney failure, at least a 50 percent reduction in eGFR, or death from kidney-related or cardiovascular causes, with a median follow-up of 3.4 years after early cessation for efficacy.
Key findings
The risk of the primary outcome was 24 percent lower with semaglutide (hazard ratio 0.76; 95% CI 0.66 to 0.88; P=0.0003). The annual eGFR slope was less steep by 1.16 ml/min/1.73 m2 per year, the risk of major cardiovascular events was 18 percent lower (hazard ratio 0.82), and death from any cause was 20 percent lower (hazard ratio 0.80); serious adverse events were less frequent with semaglutide than placebo.
Clinical implications
Semaglutide reduced clinically important kidney outcomes and cardiovascular death in patients with type 2 diabetes and chronic kidney disease. These findings support a renal- and cardio-protective role for GLP-1 receptor agonists, expanding therapeutic options beyond glycemic control in this high-risk population.
Category
Research
Source
NEJM
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