- Design
- Prespecified pooled analysis of three randomised placebo-controlled trials
- Population
- 30,787 participants with CKD or atherosclerotic cardiovascular disease, with or without diabetes
- Primary outcome
- Kidney composite including cardiovascular death
- Effect
- HR 0.84 (0.77–0.91); kidney-only composite HR 0.80 (0.69–0.92)
This prespecified pooled analysis, published in August, combined participant-level data from three placebo-controlled semaglutide trials: FLOW in CKD with type 2 diabetes, and SELECT and SOUL in atherosclerotic cardiovascular disease. Doses and routes differed — 1.0 mg and 2.4 mg weekly injections and 14 mg daily oral.
Across 30,787 participants followed for about 40 to 48 months, the kidney composite (50% eGFR decline, kidney failure, kidney or cardiovascular death) occurred in 973 people on semaglutide and 1,134 on placebo, HR 0.84. A narrower kidney-only composite gave HR 0.80. Safety was in line with the class.
Pooling trials with different populations and doses gives precision but blurs who benefits most. The composite includes cardiovascular death, which drives part of the effect. The kidney-only result is the cleaner signal.
- Count kidney protection among the reasons to choose semaglutide in cardio-kidney-metabolic disease.
- Keep RAS blockade and an SGLT2 inhibitor in place; this adds to them rather than replacing them.
- Monitor eGFR and urine albumin–creatinine ratio as usual after starting.
- Note that the benefit was seen in people with and without diabetes.
Why it matters
It extends the kidney case for semaglutide beyond the CKD-with-diabetes population FLOW studied.
Don't overread it
The primary composite includes cardiovascular death; the kidney-only effect is smaller in events and was secondary.
The statistics, in plain English
HR 0.84 means a 16% lower rate of the composite; the interval 0.77–0.91 stays below 1, so chance is an unlikely explanation. Pooling three trials of different design raises precision but not certainty about any one population.
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