The New England Journal of MedicineEffects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes

Semaglutide’s Impact on Kidney and Cardiovascular Outcomes in Diabetic Patients with Chronic Kidney Disease

Semaglutide, a GLP-1 receptor agonist, has shown promise in reducing the risk of major kidney events and cardiovascular deaths in patients with type 2 diabetes and chronic kidney disease (CKD). This study evaluates the efficacy of semaglutide in mitigating these risks compared to a placebo.

Study Design:

• Participants: 3,533 patients with type 2 diabetes and CKD
  • Semaglutide Group: 1,767 participants
  • Placebo Group: 1,766 participants
• Criteria:
  • eGFR of 50-75 ml/min/1.73 m² with a urinary albumin-to-creatinine ratio of 300-5000 mg/g
  • eGFR of 25-50 ml/min/1.73 m² with a urinary albumin-to-creatinine ratio of 100-5000 mg/g
• Intervention: Subcutaneous semaglutide 1.0 mg weekly or placebo
• Primary Outcome: Major kidney disease events (onset of kidney failure, 50% reduction in eGFR, or death from kidney-related or cardiovascular causes)
• Secondary Outcomes: Mean annual eGFR slope, major cardiovascular events, and all-cause mortality

Key Findings:

• Primary Outcome:
  • 24% lower risk of major kidney disease events in the semaglutide group (HR 0.76; 95% CI, 0.66-0.88; P=0.0003)
• Kidney-Specific Components:
  • 21% lower risk in the semaglutide group (HR 0.79; 95% CI, 0.66-0.94)
• Cardiovascular Death:
  • 29% lower risk in the semaglutide group (HR 0.71; 95% CI, 0.56-0.89)
• eGFR Slope:
  • Less steep decline in the semaglutide group by 1.16 ml/min/1.73 m² annually (P<0.001)
• Major Cardiovascular Events:
  • 18% lower risk in the semaglutide group (HR 0.82; 95% CI, 0.68-0.98; P=0.029)
• All-Cause Mortality:
  • 20% lower risk in the semaglutide group (HR 0.80; 95% CI, 0.67-0.95; P=0.01)
• Adverse Events:
  • Lower percentage of serious adverse events in the semaglutide group (49.6% vs. 53.8%)

HCN Medical Memo
For clinicians managing patients with type 2 diabetes and chronic kidney disease, semaglutide presents a valuable therapeutic option to lower the risk of major kidney and cardiovascular events. Incorporating semaglutide into treatment regimens may enhance patient outcomes and reduce the burden of these serious complications.

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