The Study
Effects of Semaglutide With or Without Concomitant Mineralocorticoid Receptor Antagonist Use in Participants With Type 2 Diabetes and Chronic Kidney Disease: A FLOW Trial Prespecified Secondary Analysis
This study is like a super fair test where half the people got a new medicine and half got a fake pill, and no one knew who got what. It shows the new medicine really helps protect kidneys and hearts in people with diabetes and kidney problems. But when they looked at whether people were already taking another medicine (MRA), the group was too small to be sure if it made a difference.
Analysis score
Maximum 90 for a randomized controlled trial.
Where the score came from
This study tested if a popular diabetes drug called semaglutide still helps protect kidneys and the heart even when patients are already taking another medicine (MRA) for kidney or blood pressure problems.
Where does this study sit?
Reviews of RCTs (Meta-analyses)
Max 100Randomized Trials
Max 90Reviews of Cohort Studies
Max 85Cohort Studies
Max 72Reviews of Case-Control Studies
Max 63Case-Control Studies
Max 58Cross-Sectional & Case Series
Max 50Expert Opinion
Max 587 / 100
Quality score
Participants are randomly assigned to treatment or control groups, minimizing bias. The gold standard for testing whether an intervention causes an effect.
Key takeaways
Summary
Based on the study abstract and findings.
- 1Yes — for someone with diabetes and kidney disease, this means semaglutide adds strong protection against kidney failure and early death, even if they’re already on other standard treatments.
- 2Semaglutide lowered the risk of kidney failure or heart death by about 24%, slowed kidney function decline by 1.2 units per year, cut urine protein by 30%, and reduced heart attacks/strokes by 18% and death by 20% — whether or not patients were on MRAs.
Score breakdown, methodology, conflicts of interest, evidence analysis & raw study data
Publication
Journal
Diabetes Care
Year
2025
Authors
P. Rossing, G. Bakris, V. Perkovic, R. Pratley, K. Tuttle, Kenneth W Mahaffey, T. Idorn, N. Belmar, H. Bosch‐Traberg, S. Rasmussen, Robert Busch, Roland E. Schmieder, Pieter Gillard, J. Mann
Related Content
Claims (8)
In patients with type 2 diabetes and chronic kidney disease, the medication semaglutide is associated with a lower chance of developing kidney failure and other kidney-related complications, even when accounting for changes in body weight.
In adults with type 2 diabetes and kidney disease, a weekly injection of semaglutide at 1.0 mg lowers the combined risk of severe kidney function decline, kidney failure, or death from kidney or heart causes by 24% compared to a placebo over about 3.4 years, regardless of whether they were already taking mineralocorticoid receptor antagonists.
In people with type 2 diabetes and kidney disease, a medication called semaglutide lowers a marker of kidney damage (urinary albumin-to-creatinine ratio) by about 30% after two years compared to a placebo, and this effect does not depend on whether they were already taking mineralocorticoid receptor antagonists.
For adults with type 2 diabetes and chronic kidney disease, taking semaglutide along with mineralocorticoid receptor antagonists does not lead to a meaningful increase in the risk of high blood potassium levels.
Semaglutide reduces kidney damage and progression in patients with type 2 diabetes and chronic kidney disease independently of weight loss, and its effect on albuminuria is consistent regardless of concomitant mineralocorticoid receptor antagonist use.
In patients with type 2 diabetes and chronic kidney disease, semaglutide lowers the risk of kidney failure and related complications regardless of weight loss, and combining it with mineralocorticoid receptor antagonists does not significantly change its safety profile.
Not medical advice. For informational purposes only. Always consult a qualified healthcare professional before making health decisions.