The headline trial: FLOW
FLOW (Effect of Semaglutide Versus Placebo on the Progression of Renal Impairment in Subjects with Type 2 Diabetes and Chronic Kidney Disease)
Perkovic et al., New England Journal of Medicine, May 2024
Semaglutide 1.0 mg weekly reduced the composite of kidney failure, a sustained 50 percent drop in eGFR, or death from kidney or cardiovascular causes by 24 percent (hazard ratio 0.76, 95% CI 0.66 to 0.88) over a median 3.4 years. The trial was stopped early for efficacy. On the strength of FLOW, Ozempic received an FDA-labeled indication in January 2025 to reduce the risk of kidney disease progression in adults with type 2 diabetes and CKD.
Trial enrollment criteria
- Adults with type 2 diabetes (HbA1c 6.5 to 10 percent)
- Chronic kidney disease: either eGFR 50 to 75 with urine albumin-to-creatinine ratio (UACR) 300 to 5000, or eGFR 25 to 50 with UACR 100 to 5000
- On maximum tolerated ACE inhibitor or ARB unless contraindicated
Does this trial apply to you?
Most chronic kidney disease in the US is driven by diabetes, and that is exactly the population FLOW studied. If you have type 2 diabetes with stage 3 or stage 4 CKD (eGFR 25 to 75) and albuminuria, semaglutide carries an FDA-labeled kidney indication as of January 2025 and a strong nephrology-guideline endorsement (KDIGO 2024). For CKD without diabetes, GLP-1 use is not yet FDA-labeled and rests on extrapolation from the diabetic-CKD trials; discuss it with your nephrologist.
What to ask your prescriber
- Most recent eGFR and UACR (urine albumin-to-creatinine ratio)
- Whether you are on the maximum tolerated dose of an ACE inhibitor or ARB
- Whether semaglutide at 1.0 mg weekly is appropriate (FLOW used 1.0 mg, not the 2.4 mg obesity dose)
- Dose-adjustment considerations at lower eGFR ranges
Editorial notes
- GLP-1 in CKD has a different evidence base, drug dose and FDA label than GLP-1 for obesity. The three are not interchangeable.
- Acute kidney injury risk rises with severe dehydration; pause the drug if you cannot keep fluids down during GI side effects.
- If you also have type 2 diabetes plus heart disease, the stacked condition pages below carry the combined organ-protection evidence.
Clinical trials for Chronic kidney disease (CKD)
Or browse the full GLP-1 clinical trials directory, filterable by condition, state and phase.
Take it to your prescriber: PA letter templates
Editable prior-authorization letter templates that cite the registration trial above. Pick the plan your prescriber will submit to, copy the template, fill in the patient-specific findings and have your clinician sign and submit.
Not seeing your plan? The full PA letter librarycovers 20 plans × 10 indications = 200 templates. The appeal letter library handles denials.
Drug profiles
Other GLP-1 conditions
Editorial provenance
Editorial review by John, Editor on 2026-05-23, against FLOW (Perkovic et al., New England Journal of Medicine, May 2024). We do not yet have a credentialed medical reviewer on staff (actively recruiting). This page summarises public registration-trial data and FDA labeling. It is not clinician-authored medical advice.
Disclaimer
Educational summary of published registration trial data. Not medical advice. Not a substitute for evaluation by a treating clinician. Trial-level results do not guarantee individual outcomes. Discuss eligibility, contraindications, dose adjustments and drug interactions with your prescriber. We do not have a credentialed medical reviewer on staff yet (actively recruiting); the content below is editor-written from public registration-trial publications and FDA labeling, not clinician-authored medical advice.