A recent study investigated the effects of semaglutide, a GLP-1 receptor agonist, on patients with type 2 diabetes and chronic kidney disease. The FLOW trial demonstrated potential benefits of semaglutide in reducing major kidney disease events or death from cardiovascular causes in this high-risk population.

The study, published in the New England Journal of Medicine, included 3,533 participants with type 2 diabetes (T2D) and chronic kidney disease (CKD). Participants were randomly assigned to receive either 1.0 mg of semaglutide weekly or a placebo. The primary outcome measured was a composite of kidney failure, a significant decline in kidney function, or death from kidney-related or cardiovascular causes.

The researchers found a 24% reduction in the risk of primary outcome events in the semaglutide group compared to the placebo group (hazard ratio, 0.76; 95% CI, 0.66 to 0.88; P=0.0003). Semaglutide also decreased the incidence of kidney failure and cardiovascular death (hazard ratio, 0.71; 95% CI, 0.56 to 0.89). Additionally, the annual decline in kidney function was slower by 1.16 ml/min/1.73 m² in the semaglutide group (P<0.001).

Secondary outcomes also showed significant benefits. There was an 18% reduction in major cardiovascular events (hazard ratio, 0.82; 95% CI, 0.68 to 0.98; P=0.029) and a 20% reduction in all-cause mortality (hazard ratio, 0.80; 95% CI, 0.67 to 0.95, P=0.01). Fewer serious adverse events were reported in the semaglutide group compared to the placebo group (49.6% vs. 53.8%).

"Our trial has important strengths," stated researchers. "The trial was large and rigorous and provides clear conclusions about benefits and risks."

However, they also mentioned that the study had "important" limitations: modest use of SGLT2 inhibitors and nonsteroidal MRAs, insufficient power to detect subgroup differences, underrepresentation of marginalized populations, and potential non-generalizability.

Given the high burden of CKD in patients with T2D, the study suggested that semaglutide may have a role in the treatment of this population. However, further research is needed to establish its place alongside current treatment protocols, which include renin-angiotensin system inhibitors and SGLT2 inhibitors.

This study was funded by Novo Nordisk, the manufacturer of semaglutide. Full list of author disclosures can be found in the original study.