Changes in Metabolic and Blood Pressure Outcomes With Semaglutide Across Chronic Kidney Disease Stages: A Post Hoc Analysis of the FLOW Trial
In brief
Semaglutide lowered HbA1c by 0.7 to 1.0 points across kidney disease groups
In a post hoc analysis of 3,533 adults with type 2 diabetes and chronic kidney disease, semaglutide reduced HbA1c by 0.7 to 1.0 percentage points and weight by 2.5 to 4.6 kg more than placebo over 104 weeks. Effects on these measures did not differ significantly across kidney function or albuminuria groups; blood pressure also improved in some groups, but the analysis was not designed to establish differences between them.
- Journal
- Diabetes, obesity & metabolism (Q1)
- Published
- 3 November 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Allon N Friedman, Jan Basile, Robert Busch, David M Charytan, Kenneth W Mahaffey, Sherif Mehanna, et al.
- PMID
- 42977539
- DOI
- 10.1111/dom.71407
Why clinicians should know about it
- Picked for Nephrology (paper of the day, 5 November 2026): Semaglutide improves HbA1c, weight, and SBP in CKD
Abstract
AIMS: To assess changes in glycated haemoglobin (HbA1c), body weight, and systolic/diastolic blood pressure (SBP/DBP) by chronic kidney disease (CKD) and albuminuria categories in a post hoc analysis of FLOW, an international, double-blind, randomized, phase 3b clinical trial of adults with CKD and Type 2 diabetes (T2D). MATERIALS AND METHODS: We evaluated the effect of semaglutide 1.0 mg versus placebo (in addition to standard of care) on changes in HbA1c, body weight, SBP, and DBP from baseline to Week 104 stratified by baseline estimated glomerular filtration rate (eGFR; ≥ 60, ≥ 45 to < 60, ≥ 30 to < 45, < 30 mL/min/1.73 m2) and urine albumin-to-creatinine ratio (UACR; < 30, 30 to < 300, and ≥ 300 mg/g). Outcomes were analysed using analysis of covariance with baseline eGFR/UACR as covariates and an interaction term for treatment group by eGFR/UACR categories. We calculated the estimated treatment difference (ETD) between the semaglutide and placebo groups. RESULTS: FLOW included 3533 participants. Compared with participants assigned placebo, those assigned semaglutide had greater reductions in HbA1c (ETD range across eGFR/UACR groups: -0.7% to -1.0%; all p < 0.0001) and body weight (ETD: -2.5 kg to -4.6 kg; all p < 0.0001 except UACR < 30) from baseline to Week 104. Participants with lower baseline eGFR/higher UACR categories treated with semaglutide also had greater improvements in SBP than those receiving placebo. In interaction analyses, the treatment effect did not differ significantly by baseline eGFR/UACR for any of the outcomes. CONCLUSIONS: Semaglutide improves glycaemic control and weight, regardless of baseline eGFR or UACR, and SBP in lower eGFR/higher UACR categories.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.