Semaglutide slows kidney disease in type 2 diabetes (FLOW)

Evidence tier

Established · GLP-1 · CKM

Plain-language summary

Among adults with type 2 diabetes and CKD, weekly semaglutide reduced the risk of major kidney events by about a quarter versus placebo; the trial stopped early for efficacy, with concordant benefits on cardiovascular events and survival.

Key findings

  • Primary composite kidney outcome: HR 0.76 (95% CI 0.66–0.88), a 24% relative risk reduction (331 vs 410 events).
  • Major cardiovascular events: HR 0.82 (95% CI 0.68–0.98).
  • All-cause mortality: HR 0.80 (95% CI 0.67–0.95).
  • Slower annual eGFR decline with semaglutide.

Population

Adults with type 2 diabetes and CKD (eGFR/albuminuria criteria for elevated risk), on maximum tolerated RAS blockade. Weekly subcutaneous semaglutide 1.0 mg (the diabetes/CKD dose, not the 2.4 mg obesity dose) vs placebo; 387 sites, 28 countries; N=3,533.

What this does not prove

FLOW tested one agent (semaglutide 1.0 mg) in one population (T2D with CKD). It does not establish a class effect for all GLP-1 receptor agonists, and does not directly answer obesity without diabetes, advanced kidney failure/dialysis, transplant recipients, or the 2.4 mg dose.

Primary source

Perkovic V, et al. N Engl J Med. 2024;391:109–121.
https://www.nejm.org/doi/full/10.1056/NEJMoa2403347

Educational only

Paraphrased from the primary publication; not individual medical advice. Verify against the source before applying to care.