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The FLOW trial evaluated once-weekly semaglutide in adults with type 2 diabetes and chronic kidney disease. The study showed that semaglutide reduced the risk of a composite kidney outcome and cardiovascular death compared with placebo, adding important evidence for renal protection with a GLP-1 receptor agonist. The results are especially relevant to general physicians because diabetic kidney disease often evolves silently and coexists with cardiovascular disease. A modern nephroprotective strategy therefore requires systematic use of albuminuria and estimated GFR, blood-pressure control and selection of therapies that modify both renal and cardiovascular risk. Semaglutide is not a substitute for established renin–angiotensin system blockade or SGLT2 inhibition where indicated; instead, it adds another evidence-based option within a layered approach. The trial also illustrates why kidney outcomes are becoming increasingly important endpoints in diabetes drug development. For routine practice, the emphasis should remain on risk stratification, persistence with therapy and periodic reassessment of kidney function and albuminuria.
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The FLOW trial evaluated once-weekly semaglutide in adults with type 2 diabetes and chronic kidney disease. The study showed that semaglutide reduced the risk of a composite kidney outcome and cardiovascular death compared with placebo, adding important evidence for renal protection with a GLP-1 receptor agonist. The results are especially relevant to general physicians because diabetic kidney disease often evolves silently and coexists with cardiovascular disease. A modern nephroprotective strategy therefore requires systematic use of albuminuria and estimated GFR, blood-pressure control and selection of therapies that modify both renal and cardiovascular risk. Semaglutide is not a substitute for established renin–angiotensin system blockade or SGLT2 inhibition where indicated; instead, it adds another evidence-based option within a layered approach. The trial also illustrates why kidney outcomes are becoming increasingly important endpoints in diabetes drug development. For routine practice, the emphasis should remain on risk stratification, persistence with therapy and periodic reassessment of kidney function and albuminuria.
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