A landmark clinical trial has revealed that semaglutide, a widely used once-weekly drug for type 2 diabetes, could significantly slow the progression of chronic kidney disease (CKD) , offering hope for a major advance globally. The findings were highlighted in an article by GeneOnline.
The study in question, known as the FLOW trial, enrolled 3,533 adults with type 2 diabetes and moderate to advanced kidney disease across 28 countries. Participants were randomised to receive either 1 mg of subcutaneous semaglutide weekly or a placebo, in addition to their standard care.
Over a median follow-up of 3.4 years, those on semaglutide experienced a 24 per cent reduction in a composite measure of ‘major kidney-disease events’ , which included kidney failure, a sustained drop in kidney filtration rate (eGFR), or death from kidney or cardiovascular causes (331 vs 410 first events).
Importantly, semaglutide also slowed the decline in kidney function: the average drop in eGFR was 1.16 ml/min/1.73 m² per year less steep in the semaglutide-treated group versus placebo.
Beyond the kidney benefits, secondary outcomes showed: an 18% lower risk of major cardiovascular events (such as heart attacks or strokes). A 20% reduction in all-cause mortality in the semaglutide arm. Fewer serious adverse events, with 49.6% of patients in the semaglutide group reporting such events, compared to 53.8% in the control group.
Commenting on the trial, Clare Morlidge, consultant renal pharmacist and deputy chair of the Renal Pharmacy Group, told The Pharmaceutical Journal that these are “hugely important” results for the NHS. Chronic kidney disease is projected to be the fifth largest cause of mortality globally by 2040, she said. Semaglutide, she added, “could become another medication in the cupboard for slowing CKD progression, alongside current treatments such as ACE inhibitors, SGLT2 inhibitors, and mineralocorticoid antagonists.”
Kidney disease is a common and serious complication of type 2 diabetes. Patients with CKD face a high risk of progressing to kidney failure, as well as elevated cardiovascular mortality. Historically, few treatments have directly targeted kidney outcomes in this population.
This trial is the first large, dedicated kidney-outcomes study (FLOW) for a GLP-1 receptor agonist like semaglutide, marking a significant milestone in diabetes and renal care.
GLP-1 receptor agonists , the class of drugs to which semaglutide belongs , are already well-known for their benefits in blood sugar control, weight loss and cardiovascular protection. Research has long suggested they might also protect the kidneys, but until now, robust, kidney-specific evidence was lacking.
A recent meta-analysis of 11 major clinical trials involving more than 85,000 individuals found that GLP-1 receptor agonists reduced the risks of kidney failure, loss of kidney function, and death by an average of 16–22%, even in patients without diabetes.
Researchers believe semaglutide’s kidney-protective effects may stem from multiple mechanisms: beyond reducing blood sugar, it may also exert anti-inflammatory, antioxidant and vasodilatory effects, which help preserve kidney health.
Real-world data supports this too: a multicentre retrospective study of high-risk diabetes patients found that initiating semaglutide was associated with a less steep decline in eGFR over time.
Meanwhile, additional studies have demonstrated that semaglutide also improves cardiovascular risk markers, including blood pressure and cholesterol, especially in patients with diabetic kidney disease.
If similar outcomes are replicated in broader populations and semaglutide gains formal approval for kidney-protective use, the implications could be profound: Fewer patients might progress to dialysis or require kidney transplants.
Cardiovascular risks could be reduced, lessening the burden of heart disease in diabetic kidney patients. Healthcare savings may be realised through reduced hospitalisations and delayed onset of kidney failure.
However, experts caution that semaglutide is unlikely to displace but rather complement existing therapies. Its greatest benefit may come when used alongside standard-of-care drugs like ACE inhibitors, SGLT2 inhibitors, and other kidney-protective treatments.
Novo Nordisk, the manufacturer behind semaglutide (branded as Ozempic and others), has already applied for regulatory label expansion in several regions based on the FLOW trial data.
Meanwhile, further research is anticipated to explore whether semaglutide might benefit people with non-diabetic kidney disease or other forms of chronic renal impairment.
In summary, the FLOW trial adds compelling evidence that semaglutide , long valued for its metabolic benefits , could become a key weapon in slowing kidney decline in people with type 2 diabetes. For patients and the NHS alike, it signals a potentially transformative step forward in managing one of diabetes’ most devastating complications.
Source:
- GeneOnline, Study Identifies Semaglutide as Potential Therapy for Slowing Kidney Disease Progression. geneonline.com
- Perkovic V et al., Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes, New England Journal of Medicine 2024. PubMed
- ADA press release on FLOW trial. American Diabetes Association
- Pharmaceutical Journal analysis. The Pharmaceutical Journal
- Meta-analysis of GLP-1 receptor agonists & kidney outcomes. The Guardian
