Kidney and Survival Benefits of Semaglutide in Diabetes With Chronic Kidney Disease: FLOW Trial Cardiovascular Subgroup Analyses
Authors' conclusion
Semaglutide improved kidney and survival outcomes in type 2 diabetes with CKD, irrespective of established ASCVD, heart failure, or high total cardiovascular disease risk.
Study context
- Population
- T2DM and chronic kidney disease (CKD), by baseline atherosclerotic cardiovascular disease (ASCVD), HF, or high total CVD risk without established CVD (10-year PREVENT score ≥20%)
- Comparison
- Semaglutide vs placebo
- Primary endpoint
- ≥50% estimated glomerular filtration rate (eGFR) decline, eGFR <15 mL/min/1.73 m², dialysis, transplantation, and kidney or CV death
Methodological detailssubgroup analysis by baseline CV status
- Subgroup analysis by baseline CV status
Primary result
As reported in the abstract
Primary kidney outcome by subgroup
Semaglutide vs PlaceboHazard ratio (95% CI)
With ASCVD: 119 of 593 vs 146 of 605
0.80(0.63–1.02)
Without ASCVD: 212 of 1,174 vs 264 of 1,161
0.74(0.62–0.89)
With HF: 67 of 342 vs 88 of 336
0.67(0.49–0.93)
Without HF: 264 of 1,424 vs 322 of 1,430
0.79(0.67–0.93)
With high total CVD risk: 134 of 675 vs 168 of 654
0.73(0.58–0.91)
Without high total CVD risk: 44 of 331 vs 58 of 340
0.73(0.49–1.08)
- NNT to prevent 1 primary kidney outcome at 3 years: ASCVD, HF, PREVENT ≥20% subgroups
- 22, 13, 17
Secondary outcomes
| Outcome | HR (95% CI) | |
|---|---|---|
| All-cause death (confirmatory secondary) by subgroup — Semaglutide vs Placebo · with ASCVD: 99 of 593 vs 121 of 605 | 0.82 (0.63–1.07) | |
| All-cause death (confirmatory secondary) by subgroup — Semaglutide vs Placebo · without ASCVD: 128 of 1,174 vs 158 of 1,161 | 0.78 (0.62–0.99) | |
| All-cause death (confirmatory secondary) by subgroup — Semaglutide vs Placebo · with HF: 64 of 342 vs 79 of 336 | 0.75 (0.54–1.05) | |
| All-cause death (confirmatory secondary) by subgroup — Semaglutide vs Placebo · without HF: 163 of 1,424 vs 200 of 1,430 | 0.81 (0.66–0.99) | |
| All-cause death (confirmatory secondary) by subgroup — Semaglutide vs Placebo · with high total CVD risk: 73 of 675 vs 98 of 654 | 0.71 (0.52–0.95) | |
| All-cause death (confirmatory secondary) by subgroup — Semaglutide vs Placebo · without high total CVD risk: 23 of 331 vs 28 of 340 | 0.82 (0.47–1.43) | |
| 0.512Hazard ratio (log scale) |
- All-cause death (confirmatory secondary) by subgroup: interaction P = 0.79 (ASCVD)
- All-cause death (confirmatory secondary) by subgroup: interaction P = 0.74 (HF)
- All-cause death (confirmatory secondary) by subgroup: interaction P = 0.63 (high total CVD risk)
Original publication
Kidney and Survival Benefits of Semaglutide in Diabetes With Chronic Kidney Disease: FLOW Trial Cardiovascular Subgroup Analyses. J Am Coll Cardiol. Published 2 June 2026. doi:10.
Summarised from the published abstract; every number is checked against it