FLOW Trial Semaglutide Kidney Outcomes — ESENeph MCQ

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ModerateDiabetic Kidney DiseaseFLOW Trial Semaglutide Kidney OutcomesESENeph

A 36-year-old woman with type 1 diabetes and CKD G3a (eGFR 55 mL/min/1.73m2) has persistent albuminuria (uACR 40 mg/mmol) despite maximum-dose ramipril. Her HbA1c is 52 mmol/mol. BP is 126/78 mmHg. She is on dapagliflozin. The FLOW trial demonstrated significant kidney benefit for which GLP-1 receptor agonist?

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Correct answer: C — Semaglutide

The FLOW trial (2024) was the first dedicated kidney outcomes trial for a GLP-1 RA. Semaglutide (subcutaneous, once weekly) demonstrated a 24% reduction in the primary composite kidney outcome (sustained ≥50% eGFR decline, kidney failure, kidney death, or cardiovascular death) compared to placebo in patients with T2DM and CKD. The trial was stopped early for efficacy. Although FLOW enrolled T2DM patients specifically, its results — combined with SUSTAIN-6 and SELECT cardiovascular data — position semaglutide as the GLP-1 RA with the strongest kidney-specific evidence. KDIGO 2024 incorporated these findings into CKD management recommendations as a potential additional pillar.

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