FLOW

FLOW tested whether semaglutide protects kidneys. Published in 2024, it randomized 3,533 people with type 2 diabetes and chronic kidney disease to semaglutide 1 mg weekly or placebo. Note the dose — this was the diabetes dose, not the 2.4 mg weight-management dose. The trial stopped early at a planned interim analysis after a median 3.4 years of follow-up.

The primary outcome bundled the events that actually matter to someone with kidney disease: starting dialysis, needing a transplant, filtration rate falling below 15, losing half of baseline kidney function, or dying from kidney or cardiovascular causes. Risk was 24% lower on semaglutide (hazard ratio 0.76; 331 versus 410 first events). Death from cardiovascular causes was 29% lower, all-cause death 20% lower, and the annual decline in filtration rate was gentler by 1.16 mL/min/1.73 m².

FLOW is the basis for Ozempic’s labeled indication to reduce the risk of sustained eGFR decline, end-stage kidney disease and cardiovascular death in adults with type 2 diabetes and chronic kidney disease. If you have both conditions, that indication exists specifically for you and is worth naming on a coverage request.

The confusion to avoid is generalizing it. FLOW enrolled people with diabetes and established kidney disease; it does not show that a GLP-1 protects healthy kidneys, and it does not speak to the 2.4 mg weight dose. Separately, many people see their creatinine tick up in the first weeks of a GLP-1 simply from reduced fluid intake and gastrointestinal losses — a dehydration effect, not kidney damage, though it is worth a call to your prescriber.

Ask whether your eGFR and urine albumin numbers put you in the FLOW population, and how often kidney function will be rechecked. Our FLOW analysis and kidney-disease patient guide go further.