Kidney and Survival Benefits of Semaglutide in Diabetes with Chronic Kidney Disease: FLOW Trial Cardiovascular Subgroup Analyses (JACC June 2026-1)-Article: Kidney and Survival Benefits of Semaglutide in Diabetes with Chronic Kidney Disease: FLOW Trial Cardiovascular Subgroup Analyses

Article: Kidney and Survival Benefits of Semaglutide in Diabetes with Chronic Kidney Disease: FLOW Trial Cardiovascular Subgroup Analyses

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This FLOW trial subgroup analysis examined whether semaglutide’s kidney and survival benefits in people with type 2 diabetes and chronic kidney disease (CKD) differed by baseline cardiovascular status. Participants were randomized to once-weekly semaglutide 1.0 mg or placebo and grouped by presence of atherosclerotic cardiovascular disease (ASCVD), heart failure, or high total cardiovascular risk (PREVENT score ≥20%) among those without known ASCVD or heart failure.<br /><br />Results showed that semaglutide consistently reduced the risk of the primary kidney outcome—50% eGFR decline, kidney failure, or kidney/cardiovascular death—across all cardiovascular subgroups, with no meaningful interaction by ASCVD, heart failure, or PREVENT score. It also reduced all-cause mortality similarly across subgroups. The estimated number needed to treat over 3 years to prevent one primary kidney event was 22 in the ASCVD subgroup, 13 in the heart failure subgroup, and 17 in the high-risk PREVENT subgroup.<br /><br />Semaglutide also preserved kidney function, improving eGFR slope, reduced albuminuria, and lowered inflammation (hsCRP) regardless of cardiovascular status. Benefits were consistent across heart failure subtypes and functional classes, and lower kidney risk was seen across the full range of PREVENT scores.<br /><br />The main conclusion is that semaglutide improves kidney and survival outcomes in people with type 2 diabetes and CKD irrespective of established ASCVD, heart failure, or high cardiovascular risk. This supports semaglutide as an important cardio-kidney-metabolic therapy for a broad CKD population.

Meta Tag

Concept FLOW Trial

Concept Semaglutide

Concept Chronic Kidney Disease

Concept Type 2 Diabetes

Concept Primary Endpoint

Keywords

semaglutide

type 2 diabetes

chronic kidney disease

cardiovascular status

atherosclerotic cardiovascular disease

heart failure

kidney outcomes

all-cause mortality

eGFR decline

albuminuria

FLOW Trial

Semaglutide

Chronic Kidney Disease

Type 2 Diabetes

Primary Endpoint