Description
The FLOW trial randomised 3,533 patients with type 2 diabetes and CKD to weekly semaglutide 1.0 mg or placebo and was stopped early for efficacy after a median 3.4 years.1 Semaglutide reduced the primary major‑kidney‑event outcome by 24% (331 vs 410 events; HR 0.76) and slowed the annual eGFR decline by 1.16 mL/min/1.73 m², indicating clinically meaningful preservation of renal function.1 Cardiovascular benefits accompanied renal protection: MACE fell by 18% (HR 0.82) and all‑cause mortality by 20% (HR 0.80), with fewer serious adverse events on semaglutide (49.6% vs 53.8%).1 Subgroup analyses show consistent kidney and mortality benefits across ASCVD, heart‑failure, and high‑risk strata.2 Numbers needed to treat over three years were low (eg, 13–22 depending on the subgroup), reinforcing clinical efficiency. FLOW— the first GLP‑1 trial powered for kidney outcomes—supports semaglutide as a compelling option for albuminuric CKD in type 2 diabetes and underpins guideline recommendations to add GLP‑1 therapy when albuminuria persists despite RAS blockade and SGLT2 inhibition.1