Understanding Semaglutide for Diabetes and CKD, with Pranav Garimella, MBBS, MPH

The growing influence of GLP-1 receptor agonists (GLP-1 RAs) has reshaped treatment strategies across multiple specialties, from endocrinology to cardiology and nephrology. Initially developed for glycemic control in type 2 diabetes, these agents have expanded their clinical reach, demonstrating benefits in weight loss, cardiovascular disease, and most recently, kidney protection.

On January 28, 2025, the US Food and Drug Administration approved Novo Nordisk’s semaglutide (Ozempic) for adults with type 2 diabetes and chronic kidney disease (CKD). The decision was based on results from the phase 3b FLOW kidney outcomes trial demonstrating semaglutide’s statistically significant and superior 24% relative risk reduction of kidney disease worsening, end-stage kidney disease, and death due to cardiovascular disease compared with placebo when added to standard of care.1

Initially approved in 2017 to improve blood sugar, along with diet and exercise, in adults with type 2 diabetes, semaglutide was granted an additional indication in 2020 to reduce the risk of major cardiovascular events such as heart attack, stroke, or death in adults with type 2 diabetes and known heart disease. Now, the GLP-1 RA is also approved for adults with type 2 diabetes and CKD.1

According to the US Centers for Disease Control and Prevention, approximately 1 in 3 adults with diabetes has CKD. It is the leading cause of kidney failure, accounting for 44% percent of new cases.2,3

“Any drug or any intervention that can help stem the progression to end-stage kidney disease is an incredibly important tool,” Pranav Garimella, MBBS, MPH, chief medical officer of the American Kidney Fund, told HCPLive. “Historically, we had limited medications to stem the progression of kidney disease and diabetes. This has changed over the last decade, and we're hopeful that as we have more tools in our armamentarium, we will decrease the progression of kidney disease to kidney failure and transplantation in this high-risk population.”

Garimella went on to explain the significance of now having a treatment that has a cardiovascular effect, noting clinicians will be more likely to treat these patients with drugs that target organ damage across the entire vascular bed rather than just controlling diabetes.

“We used to have RAAS inhibitors. Then there were the SGLT2 inhibitors, and now we have GLP-1 agonists. We are really strengthening how we treat the progression of kidney disease, and the foundations of it have just gotten stronger with the addition of semaglutide,” Garimella said. “We are incredibly thankful for all the innovation that's being done and having something that can actually prevent complications and death. We now need to find a way to implement this and get it across to patients who need it most.”

References

1. Brooks A. FDA Approves Semaglutide (Ozempic) for Type 2 Diabetes, Chronic Kidney Disease. HCPLive. January 28, 2025. Accessed January 30, 2025. https://www.hcplive.com/view/fda-approves-semaglutide-ozempic-type-2-diabetes-chronic-kidney-disease
2. US Centers for Disease Control and Prevention. Chronic Kidney Disease. Accessed January 30, 2025. https://www.cdc.gov/diabetes/diabetes-complications/diabetes-and-chronic-kidney-disease.html
3. National Kidney Foundation. Diabetes and Chronic Kidney Disease. Accessed January 30, 2025. https://www.kidney.org/diabetes-and-chronic-kidney-disease