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Perkovic et al. Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes. N Engl J Med. 2024;391(2):109-121. PMID 38785209

One-paragraph summary

FLOW randomized 3,533 people with type 2 diabetes and albuminuric CKD to weekly semaglutide 1 mg or placebo; the trial stopped early after a prespecified interim analysis and median follow-up was 3.4 years.

Key findings

  • Primary major-kidney-event composite: 331 versus 410 first events; HR 0.76 (95% CI 0.66–0.88). (Perkovic 2024, PMID 38785209)
  • Kidney-specific composite: HR 0.79 (95% CI 0.66–0.94). (Perkovic 2024, PMID 38785209)
  • Annual eGFR slope difference: 1.16 mL/min/1.73 m² favouring semaglutide. (Perkovic 2024, PMID 38785209)
  • All-cause death: HR 0.80 (95% CI 0.67–0.95). (Perkovic 2024, PMID 38785209)

Limitations

  • Population had type 2 diabetes and albuminuric CKD; transport to non-diabetic CKD is untested.
  • Early stopping can magnify effect estimates.
  • Baseline SGLT2 use was not randomized.

Why it matters

It was the first dedicated GLP-1 receptor-agonist kidney-outcome trial and completed the modern four-class diabetic-CKD evidence platform.

Cited by wiki pages

  • glp1 and emerging therapy
  • diabetic kidney disease
  • overview