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GLP-1 RA Second-Line CKD FLOW Trial Position — ESENeph MCQ

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ModerateDiabetic Kidney DiseaseGLP-1 RA Second-Line CKD FLOW Trial PositionESENeph

A 50-year-old woman with CKD G4 (eGFR 20 mL/min/1.73m2) and type 2 diabetes has an HbA1c of 58 mmol/mol. She is on insulin and has poor glycaemic control with frequent hyperglycaemia. Her nephrologist recommends adding a GLP-1 receptor agonist. According to KDIGO 2024, what is the position of GLP-1 RAs in CKD management?

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Correct answer: D — Second-line to SGLT2i for CKD progression benefit, with cardiovascular and metabolic advantages

KDIGO 2024 CKD guideline positions GLP-1 receptor agonists (semaglutide, liraglutide, dulaglutide) as second-line to SGLT2i for patients with T2DM and CKD, particularly those with obesity or high cardiovascular risk. The FLOW trial (semaglutide) demonstrated significant reduction in kidney disease progression in T2DM with CKD. GLP-1 RAs offer: kidney protection (FLOW trial), cardiovascular benefit (LEADER, SUSTAIN-6), weight loss, and glucose-lowering without hypoglycaemia. They can be used alongside SGLT2i and RASi. Dose adjustment is needed for some GLP-1 RAs in CKD. GI side effects (nausea, vomiting) can be mitigated by slow dose titration.

Reference: KDIGO 2024 – CKD Guideline; Perkovic et al 2024 – FLOW Trial