July 2026
Semaglutide linked to better kidney and survival outcomes in patients with CKD and diabetes
By Rebecca Jenkins
Semaglutide improves kidney and survival outcomes in people with type 2 diabetes and chronic kidney disease (CKD) regardless of baseline cardiovascular disease risk, according to a secondary analysis of a randomised controlled trial.
The original FLOW (Evaluate Renal Function with Semaglutide Once Weekly) trial in 3533 patients with type 2 diabetes and CKD found subcutaneous semaglutide 1 mg once weekly reduced the risk of the primary kidney endpoint (at least a 50% decline of estimated glomerular filtration rate, kidney failure or kidney or cardiovascular death) by 24% and all-cause death by 20%.
In the secondary analysis, published in the Journal of the American College of Cardiology, researchers found that semaglutide improved kidney and survival outcomes in this population, irrespective of established atherosclerotic cardiovascular disease (ASCVD), heart failure or high total cardiovascular risk.
At baseline, one in three patients had established ASCVD and nearly one in five had heart failure.
In those without cardiovascular disease (CVD) at baseline, two-thirds were at high cardiovascular risk (20% or greater PREVENT score in patients without established CVD).
The number needed to treat to prevent one primary kidney outcome at three years was 22 in the ASCVD subgroup, 13 in the heart failure subgroup and 17 in the high total CVD risk subgroup.
‘The effect of semaglutide vs placebo on the primary kidney outcome showed consistently lowered risks across the entire range of PREVENT scores in the FLOW trial,’ the study authors concluded.
Commenting on the analysis, Dr Hannah Wallace, Nephrologist at Austin and Western Health, Melbourne, said the findings reinforced the benefits of semaglutide in reducing cardio-kidney risk in patients with high-risk CKD and type 2 diabetes, regardless of baseline CVD risk.
Dr Wallace noted that the therapy’s current PBS listing is for people with inadequately controlled type 2 diabetes despite other therapies. However, it does have a TGA indication for reducing the risk of kidney function decline in patients with type 2 diabetes and CKD.
‘The findings from the FLOW trial and this subanalysis further support prioritising semaglutide in patients with kidney disease who meet the PBS indication for prescription,’ Dr Wallace told Medicine Today.
They also highlighted the importance of earlier detection of CKD in people with type 2 diabetes.
‘The majority of early CKD in Australia is undiagnosed, with identification requiring both an estimated glomerular filtration rate and a urine albumin-to-creatinine ratio,’ Dr Wallace said.
‘Early identification and proactive management of CKD in diabetes are essential for improving cardio-kidney outcomes through guideline-directed medical therapy alongside lifestyle interventions.’