Semaglutide Improves Kidney, Survival and Quality-of-Life Outcomes in Type 2 Diabetes and CKD
Semaglutide improves kidney, survival, and quality-of-life outcomes in type 2 diabetes with CKD, per FLOW trial analyses. Benefits were consistent across cardiovascular and severity subgroups, adding eight full-health days per year.
New analyses of the FLOW trial show that semaglutide improves kidney and survival outcomes in people with type 2 diabetes and chronic kidney disease regardless of baseline cardiovascular risk or CKD severity, and that two years of treatment improves health-related quality of life.
The FLOW trial (Evaluate Renal Function with Semaglutide Once Weekly, NCT03819153) was the first dedicated kidney outcomes trial for a GLP-1 receptor agonist. It randomly assigned 3,533 adults with type 2 diabetes and CKD to subcutaneous semaglutide 1 mg once weekly or placebo. The primary results, published in the New England Journal of Medicine, demonstrated that semaglutide reduced the risk of the composite of major kidney outcomes and all-cause death by 24% and all-cause death by 20% over approximately 3.5 years.
A secondary analysis published in the Journal of the American College of Cardiology on June 2, 2026, found that semaglutide improved kidney and survival outcomes regardless of established atherosclerotic cardiovascular disease, heart failure, or high total cardiovascular risk. The hazard ratio for all-cause death was 0.82 in patients with and without established cardiovascular disease. 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 cardiovascular risk subgroup. At baseline, one in three participants had established ASCVD and nearly one in five had heart failure; among those without cardiovascular disease, two-thirds were at high cardiovascular risk based on a PREVENT score of 20% or greater.
A post hoc analysis evaluated the benefits across a broad range of CKD severity. The primary outcome occurred in 19% of participants receiving semaglutide and 23% of those receiving placebo (HR, 0.76; 95% CI, 0.66-0.88). Fatalities occurred in 13% and 16%, respectively. Hazard ratios for the primary outcome were consistent across eGFR and UACR subgroups, supporting semaglutide treatment for patients with type 2 diabetes with all levels of CKD severity.
At the annual congress of the European Renal Association, held June 3-6 in Glasgow, prespecified analyses of patient-reported outcomes from FLOW showed that health utility scores, measured with the EQ-5D-5L questionnaire at week 104, stabilized with semaglutide and worsened with placebo, with an estimated treatment difference of 0.021 ± 0.005 — equivalent to eight additional days spent in full health per year. All dimension-specific scores improved with semaglutide except anxiety/depression, and visual analog scale scores improved more with semaglutide (estimated treatment difference 2.15 ± 0.51). The study authors said the findings reinforce the importance of a broader, patient-centered approach to treatment goals and suggest that overall well-being may improve with semaglutide despite gastrointestinal side effects, complementing previously reported reductions in kidney and mortality risks.
Several authors disclosed ties to Novo Nordisk, which manufactures semaglutide.