Abstract: TH-PO1194
Going with the FLOW: A Large Registry Study on Semaglutide and the Risk of Kidney Complications in Patients with Early Diabetic Kidney Disease
Session Information
- Late-Breaking Research Posters
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Aharon-Hananel, Genya, Hadassah University Medical Center, Jerusalem, Jerusalem District, Israel
- Mann, Johannes F., Friedrich-Alexander-Universitat Erlangen-Nurnberg Medizinische Fakultat, Erlangen, BY, Germany
- Aharonovich, Alona, Novo Nordisk A/S, Bagsværd, Capital Region of Denmark, Denmark
- Leopold, Efrat, Maccabi Healthcare Services, Tel Aviv-Yafo, Tel Aviv District, Israel
- Chernin, Gil, Kaplan Medical Center, Rehovot, Center District, Israel
Background
Semaglutide reduced the risk of major kidney events in advanced Diabetic Kidney Disease (DKD) in the FLOW trial, but its effect at earlier stages remains unclear. We assessed whether the use of semaglutide is associated with kidney benefits in type 2 diabetes (T2D) patients with low to moderate kidney risk, as defined by KDIGO.
Methods
This retrospective study included adult T2D patients from Maccabi Healthcare Services (serving~175000 T2D patients). Patients, initiating semaglutide or DPP-4 inhibitors were propensity score-matched (1:1) based on 16 major parameters. Primary composite outcome was first occurrence of eGFR decline ≥30%, end stage kidney disease (ESKD), new or worsening albuminuria or all-cause mortality over 3 years.
Results
Propensity score matching resulted in 7,720 patients per arm with (mean [±SD]) age 61.9 [11.3] Y, eGFR 87.0 [16.8] ml/min/1.73 m2, UACR 22.1 [43.9] mg/g. The rate of the primary outcome was lower in the semaglutide arm vs DPP4 inhibitors (769 [10.0%] vs 1030 [13.3%] events; HR 0.79 [95% CI, 0.72–0.87]). Benefit was shown across subgroups: low/moderate kidney risk; with/without SGLT2i use at baseline. Lower all-cause mortality rate was demonstrated in the semaglutide arm vs DPP4 inhibitors (Table, Figure1).
Conclusion
In this large real-world study use of semaglutide was associated with reduced risk of kidney complications in T2D patients with low to moderate kidney risk, suggesting that earlier intervention may prevent DKD progression, thus complementing the FLOW trial findings.
Composite Primary Outcome
| Semaglutide (N=7720) | DPP4 inhibitors (N=7720) | p-value | |
| Outcome n of events (%) | |||
| Primary composite outcome | 769 (10.0) | 1030 (13.3) | <0.001 |
| eGFR ≥ 30% decline | 216 (2.8) | 319 (4.1) | <0.001 |
| Albuminuria onset/worsening | 634 (8.2) | 816 (10.6) | <0.001 |
| ESKD onset | 3 (<0.1) | 2 (<0.1) | >0.9 |
| All cause death | 94 (1.2) | 209 (2.7) | <0.001 |
Funding
- Commercial Support – Novo Nordisk