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Kidney and Survival Benefits of Semaglutide in Diabetes With Chronic Kidney Disease: FLOW Trial Cardiovascular

Katherine R Tuttle1, George L Bakris, Florian M M Baeres2

  • 1Division of Nephrology, University of Washington School of Medicine, Seattle, Washington, USA; Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA.

Journal of the American College of Cardiology
|June 3, 2026
PubMed

Insights

Semaglutide significantly improved kidney and survival outcomes for patients with type 2 diabetes and chronic kidney disease (CKD), regardless of their cardiovascular disease status. This finding highlights semaglutide

Area of Science:

  • Nephrology and Endocrinology
  • Cardiovascular Medicine
  • Clinical Trials

Background:

  • Cardiovascular disease (CVD) is a major risk factor for chronic kidney disease (CKD) progression and mortality in individuals with type 2 diabetes (T2D).
  • Understanding the impact of treatments on kidney and survival outcomes across different cardiovascular risk profiles is crucial for managing T2D patients with CKD.

Purpose of the Study:

  • To evaluate the efficacy of semaglutide in improving kidney and survival outcomes in patients with T2D and CKD.
  • To assess these effects based on participants' baseline cardiovascular status, including atherosclerotic cardiovascular disease (ASCVD), heart failure, and high total CVD risk.

Main Methods:

  • The randomized, placebo-controlled FLOW trial enrolled participants with T2D and CKD.
  • Participants received once-weekly subcutaneous semaglutide 1.0 mg or a placebo.
  • Subgroup analyses were performed based on established ASCVD, presence of heart failure, and a high 10-year PREVENT score (≥20%). The primary outcome included a composite of ≥50% estimated glomerular filtration rate (eGFR) decline, eGFR <15 mL/min/1.73 m2, kidney failure, or kidney/cardiovascular death. All-cause death was a secondary outcome.

Main Results:

  • Semaglutide demonstrated a significant reduction in the primary composite kidney outcome across all assessed cardiovascular subgroups, including those with ASCVD, heart failure, or high total CVD risk.
  • Hazard ratios for the primary outcome ranged from 0.67 to 0.80 in subgroups with established CVD and 0.73 to 0.79 in subgroups without established CVD, indicating consistent benefits.
  • Semaglutide also reduced the risk of all-cause mortality across these subgroups, with hazard ratios ranging from 0.71 to 0.82.

Conclusions:

  • Semaglutide significantly improves kidney and survival outcomes in patients with type 2 diabetes and CKD.
  • The benefits of semaglutide on renal and cardiovascular outcomes are consistent across diverse baseline cardiovascular risk profiles, including patients with established ASCVD, heart failure, or high total CVD risk.
  • The findings from the FLOW trial support the use of semaglutide as a therapeutic option for managing CKD in patients with T2D, irrespective of their cardiovascular status.
Abstract

Keywords:
atherosclerotic cardiovascular diseasecardiovascular riskglomerular filtration rateglucagon-like peptide-1heart failuremortality

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