FLOW (Semaglutide in Diabetic Kidney Disease)

Design

3,533 adults with T2D and CKD (eGFR 25–75 mL/min/1.73m² with albuminuria, or eGFR 50–75 with severe albuminuria) randomised to weekly semaglutide 1.0 mg SC or placebo. Stopped early for efficacy at median 3.4 years.

Findings

• Primary composite (kidney failure, ≥50% eGFR decline, kidney death, cardiovascular death): 24% relative reduction.
• eGFR decline: slowed by ~1.16 mL/min/yr.
• Major CV events: 18% reduction.
• All-cause mortality: 20% reduction.
• Adverse events: as expected for GLP-1 class (GI, gallstones).

Why it matters

• Adds semaglutide to the established CKD-protective drug classes (RAAS blockade, SGLT2 inhibitors, finerenone) in T2D.
• Substantial all-cause mortality reduction is a striking signal.
• Implications for combining semaglutide with SGLT2 inhibitors for T2D + CKD — an active question.

Practical translation

Semaglutide is now a preferred T2D agent in CKD, alongside SGLT2 inhibitors. Triple therapy (RAAS blocker + SGLT2i + GLP-1) is increasingly common in advanced T2D-CKD.

Related entries

GLP-1 agonists, Chronic kidney disease, SGLT2 inhibitors, Type 2 diabetes.