Semaglutide reduced major kidney events by 24% in adults with T2D and CKD — the FLOW trial. Stopped early for efficacy. Establishes GLP-1 RAs alongside SGLT2 inhibitors as renoprotective in T2D + CKD.
The evidence
FLOW (NEJM 2024): 3,533 adults with T2D and stage 2-4 CKD (eGFR 25-75 with elevated albuminuria). Semaglutide 1.0 mg weekly vs placebo on top of standard renoprotective therapy (ACE/ARB). Composite kidney endpoint HR 0.76. Kidney failure HR 0.80. Kidney or CV death HR 0.71. All-cause mortality HR 0.80. Stopped early.
FDA-approved labeling status
FLOW was T2D-only. KDIGO 2024 guidelines now recommend GLP-1 RAs in T2D + CKD. FLOW used semaglutide 1.0 mg weekly — not the 2.4 mg used for weight indications.
Practical considerations
Combination GLP-1 + SGLT2 inhibitor + ACE/ARB is increasingly the standard in T2D + CKD. Dose consideration: FLOW used 1.0 mg, not 2.4 mg.