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, sustained 50% reduction in eGFR or death from kidney or cardiovascular causes by 24 percent (hazard ratio 0.76, 95% CI 0.66–0.88, p<0.001) over a median 3.4 years of follow-up. The trial was stopped early for efficacy.
Trial enrollment criteria
- Adults with type 2 diabetes (HbA1c 6.5 to 10 percent)
- Chronic kidney disease defined as either: eGFR 50 to 75 mL/min/1.73m² with urine albumin-to-creatinine ratio (UACR) 300 to 5000, OR eGFR 25 to 50 mL/min/1.73m² with UACR 100 to 5000
- On maximum tolerated dose of renin-angiotensin system blockade (ACE inhibitor or ARB) unless contraindicated
Does this trial apply to you?
If you have T2D and your nephrologist or PCP has documented stage 3 or stage 4 CKD (eGFR 25 to 75) with albuminuria, you may meet FLOW-trial enrollment criteria. Semaglutide is FDA-labeled for T2D; the kidney-protective benefit is now reflected in major nephrology guidelines (KDIGO 2024 update).
What to ask your prescriber
- Most recent eGFR and UACR (urine albumin-to-creatinine ratio)
- Whether you are on maximum tolerated 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 RA in CKD has a different evidence base than GLP-1 RA for obesity. The drug dose, the trial, and the FDA label are not interchangeable.
- Patients on insulin and GLP-1 RA together require closer hypoglycemia monitoring.
- Acute kidney injury risk increases with severe dehydration; pause the drug if you cannot maintain hydration during GI side effects.
Clinical trials for Type 2 diabetes with chronic kidney disease
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.