{"id":"4b3b7465d8a0","type":"article","url":"https://hartvaat.nl/2024/07/11/flow-semaglutide-beschermt-nieren-bij-type-2-diabetes-en-ckd-nejm-gerelateerd/","title":"FLOW: semaglutide beschermt nieren bij type 2 diabetes en CKD — NEJM-gerelateerd","title_en":"Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["anemie-ckd","cardiorenal-behandelstrategie","chronische-nierziekte","credence-trial","cystatine-c","diabetes-en-hart","diabetes-type-2","fidelio-dkd","figaro-dkd","flow-trial","select-trial","semaglutide","soul-trial","step-hfpef","stride-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2403347","source_url":"https://doi.org/10.1056/NEJMoa2403347","authors":["Vlado Perkovic","Katherine R Tuttle","Peter Rossing","Kenneth W Mahaffey","Johannes F E Mann","George Bakris","Florian M M Baeres","Thomas Idorn","Heidrun Bosch-Traberg","Nanna Leonora Lausvig","Richard Pratley"],"significance":10,"published":"2024-07-11","source_date":"2024-07-11","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/"],"congress":"","summary_en":"The FLOW trial demonstrated that semaglutide significantly slowed kidney disease progression in patients with type 2 diabetes and CKD, reducing the composite of sustained eGFR decline, kidney failure, and renal or cardiovascular death. The trial was stopped early for efficacy, establishing GLP-1 receptor agonists as a new renoprotective therapy alongside SGLT2 inhibitors.","created":"2026-07-03T10:31:02Z","updated":"2026-07-03T13:30:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De FLOW-trial toonde dat semaglutide de nierziektesprogressie significant vertraagde bij patiënten met type 2 diabetes en CKD. Het middel verminderde de eGFR-daling en het risico op niergebeurtenissen, wat GLP-1-agonisten als nierbeschermers positioneert naast SGLT2-remmers.","abstract_original":"BACKGROUND: Patients with type 2 diabetes and chronic kidney disease are at high risk for kidney failure, cardiovascular events, and death. Whether treatment with semaglutide would mitigate these risks is unknown. METHODS: We randomly assigned patients with type 2 diabetes and chronic kidney disease (defined by an estimated glomerular filtration rate [eGFR] of 50 to 75 ml per minute per 1.73 m2 of body-surface area and a urinary albumin-to-creatinine ratio [with albumin measured in milligrams and creatinine measured in grams] of >300 and <5000 or an eGFR of 25 to <50 ml per minute per 1.73 m2 and a urinary albumin-to-creatinine ratio of >100 and <5000) to receive subcutaneous semaglutide at a dose of 1.0 mg weekly or placebo. The primary outcome was major kidney disease events, a composite of the onset of kidney failure (dialysis, transplantation, or an eGFR of <15 ml per minute per 1.73 m2), at least a 50% reduction in the eGFR from baseline, or death from kidney-related or cardiovascular causes. Prespecified confirmatory secondary outcomes were tested hierarchically. RESULTS: Among the 3533 participants who underwent randomization (1767 in the semaglutide group and 1766 in the placebo group), median follow-up was 3.4 years, after early trial cessation was recommended at a prespecified interim analysis. The risk of a primary-outcome event was 24% lower in the semaglutide group than in the placebo group (331 vs. 410 first events; hazard ratio, 0.76; 95% confidence interval [CI], 0.66 to 0.88; P = 0.0003). Results were similar for a composite of the kidney-specific components of the primary outcome (hazard ratio, 0.79; 95% CI, 0.66 to 0.94) and for death from cardiovascular causes (hazard ratio, 0.71; 95% CI, 0.56 to 0.89). The results for all confirmatory secondary outcomes favored semaglutide: the mean annual eGFR slope was less steep (indicating a slower decrease) by 1.16 ml per minute per 1.73 m2 in the semaglutide group (P<0.001), the risk of major cardiovascular events 18% lower (hazard ratio, 0.82; 95% CI, 0.68 to 0.98; P = 0.029), and the risk of death from any cause 20% lower (hazard ratio, 0.80; 95% CI, 0.67 to 0.95, P = 0.01). Serious adverse events were reported in a lower percentage of participants in the semaglutide group than in the placebo group (49.6% vs. 53.8%). CONCLUSIONS: Semaglutide reduced the risk of clinically important kidney outcomes and death from cardiovascular causes in patients with type 2 diabetes and chronic kidney disease. (Funded by Novo Nordisk; FLOW ClinicalTrials.gov number, NCT03819153.)."}