Theme

Semaglutide Drives Kidney Risk Reversal

Source
Source: Tuttle KR, Bain SC, Bosch-Traberg H, et al. Effects of Once-Weekly Semaglutide on Kidney Disease Outcomes by KDIGO Risk Category in the SUSTAIN 6 Trial. Kidney Int Rep. 2024;9:2006–2015.

Outcomes Improvement Across All KDIGO Categories (SUSTAIN 6 Post Hoc Analysis)

Population

3,238 adults with T2D & established CV disease/risk.

Comparison

Semaglutide vs. Placebo.
Stratified by KDIGO Risk.

Duration

2 years (Median follow-up 2.1 years).

KDIGO IMPROVEMENT ODDS
69%

Increased odds of shifting to a lower risk category vs. placebo.
(OR: 1.69; 95% CI: 1.32–2.16; P < 0.0001)

Relative Risk Reduction Profile

Composite Reduction
36%
Lower risk of macroalbuminuria, eGFR <45, KRT, or renal death.
eGFR Slope
+1.20
mL/min/1.73m²/year preserved vs. placebo.
Worsening Odds
0.71
Significantly reduced likelihood of deteriorating to higher KDIGO risk.

Clinical Recommendation: Active Risk Regression

Move beyond solely glycemic control. Implement routine KDIGO stratification (eGFR & UACR) for all T2D patients. Initiate Once-Weekly Semaglutide early to drive risk regression and utilize renal protective benefits across Low, Moderate, and High risk categories.

AbbreviationsQuick
CI, confidence interval; CKD, chronic kidney disease; CV, cardiovascular; eGFR, estimated glomerular filtration rate; GLP-1RA, glucagon-like peptide-1 receptor agonist; HR, hazard ratio; KDIGO, Kidney Disease: Improving Global Outcomes; OR, odds ratio; T2D, type 2 diabetes; UACR, urine albumin-to-creatinine ratio.
Bibliography8
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  6. de Boer IH, Khunti K, Sadusky T, et al. Diabetes management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and kidney disease: improving global outcomes (KDIGO). Diabetes Care. 2022;45:3075–3090. (DOI: 10.2337/dci22-0027)
  7. Afkarian M, Zelnick LR, Hall YN, et al. Clinical manifestations of kidney disease among US adults with diabetes, 1988-2014. JAMA. 2016;316:602–610. (DOI: 10.1001/jama.2016.10924)
  8. Tuttle KR, Bosch-Traberg H, Cherney DZI, et al. Post hoc analysis of SUSTAIN 6 and pioneer 6 trials suggests that people with type 2 diabetes at high cardiovascular risk treated with semaglutide experience more stable kidney function compared with placebo. Kidney Int. 2023;103:772–781. (DOI: 10.1016/j.kint.2022.12.028)