In Brief | Chronic Kidney Disease
A sub-study of the FLOW trial suggests that the benefits of semaglutide are independent of the use of mineralocorticoid receptor agonists
Time to read: 02:03
Time to listen: 03:52
Originally Published: 24 August 2024
Sourced: NEJM
Type of article: In Brief
MedED Catalogue Reference: MNCIB001
Category: CKD
Cross Reference: Diabetes, Gerontology, Cardiovascular Disease
Keywords: semaglutide, diabetes, CKD, renal disease, cardiovascular events
The benefits of semaglutide in reducing kidney disease progression, cardiovascular events, and mortality risks in patients with type 2 diabetes and chronic kidney disease (CKD) were observed, regardless of whether patients were also receiving mineralocorticoid receptor antagonists (MRAs).
Originally published in NEJM, supplemented by EASD coverage from Medscape.This summary does not represent the original research, nor is it intended to replace the original research. Access the full Disclaimer Information
At the recent European Association for the Study of Diabetes (EASD) meeting, researchers presented the results of their sub-study analysis of the FLOW trial, which aimed to evaluate whether the established benefits of semaglutide in reducing kidney disease, cardiovascular, and mortality risks in people with type 2 diabetes and chronic kidney disease (CKD), would be observed regardless of whether these patients were receiving a mineralocorticoid receptor antagonists (MRA).
Since MRAs are known for their long-term cardio-renal benefits and were used by some participants in the FLOW trial, the authors conducted their pre-specified sub-study analysis in patients who had been using MRAs at the start of the FLOW trial (n = 257) compared to those who had not (n = 3276).
The findings were as follows:
- Baseline characteristics were similar between both groups, including eGFR levels (46 vs 44 mL/min/1.73 m²) and urine albumin-creatinine ratios (536 vs 569 mg/g).
- Over a median follow-up of 3.4 years, semaglutide reduced the primary composite kidney outcome by 49% in MRA users (HR, 0.51) and 21% in non-MRA users (HR, 0.79), with no statistically significant interaction between the groups (P =.12).
- The results suggest no difference in semaglutide’s effect on kidney outcomes whether or not patients were on an MRA.
- Kidney, cardiovascular disease, and heart failure outcomes, including eGFR decline and major cardiovascular events, showed no significant interactions between MRA and non-MRA groups.
- There were no significant safety concerns with semaglutide and MRAs, although a slight increase in hyperkalemia was observed in MRA users (22.8% vs 13.9%).
- Overall, no unexpected adverse events were noted with the combination of semaglutide and MRAs.
Based on these findings, the researchers concluded that the benefit of semaglutide in reducing the risk of CKD progression, cardiovascular events, and death in patients with type 2 diabetes and CKD appears to be independent of concurrent MRA use and suggest that these drugs work independently, with potentially additive effects when combined
Medscape. (2024). Combining semaglutide and mineralocorticoids may improve CKD. https://www.medscape.com/viewarticle/combining-semaglutide-and-mineralocorticoids-may-improve-ckd-2024a1000h1j
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