Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes

Design

• Double-blind RCT; n = 3,533 (1,767 semaglutide vs 1,766 placebo)
• Population: type 2 diabetes + CKD defined by eGFR 50–75 ml/min/1.73 m² and UACR >300 and <5000 mg/g, or eGFR 25 to <50 and UACR >100 and <5000 mg/g (ratio definition per NEJM)
• Intervention: once-weekly semaglutide 1.0 mg vs placebo on standard care
• Median follow-up: 3.4 y (stopped early after prespecified interim analysis)

Primary outcome (major kidney disease events)

Composite of onset of kidney failure (dialysis, transplantation, or eGFR <15 ml/min/1.73 m²), ≥50% reduction in eGFR from baseline, or death from kidney-related or cardiovascular causes.

• Events: 331 (semaglutide) vs 410 (placebo); HR 0.76 (95% CI 0.66–0.88; P = 0.0003)

Selected secondary / hierarchical outcomes (abstract)

• Kidney-specific components composite: HR 0.79 (95% CI 0.66–0.94)
• Cardiovascular death: HR 0.71 (95% CI 0.56–0.89)
• 3-point MACE: HR 0.82 (95% CI 0.68–0.98; P = 0.029)
• All-cause mortality: HR 0.80 (95% CI 0.67–0.95; P = 0.01)
• Mean annual eGFR slope: less steep decline by 1.16 ml/min/1.73 m² (P < 0.001)

Evidence hygiene

• Population-specific: T2D + CKD—do not merge with STEP-1 obesity-without-diabetes evidence.
• Dose: 1.0 mg weekly here vs 2.4 mg obesity/HFpEF programmes elsewhere.

Publication

Perkovic V, Tuttle KR, Rossing P, et al. N Engl J Med. 2024 Jun 13;390(22):2079–2091. PMID 38785209.