Hormonal
Once-weekly subcutaneous semaglutide 2.4 mg reduces the risk of major kidney composite endpoints (including macroalbuminuria and persistent eGFR decline) in patients with overweight/obesity and established cardiovascular disease, regardless of diabetes status.
If you have obesity and heart disease but no diabetes, semaglutide 2.4mg weekly offers significant kidney protection. It reduces the risk of serious kidney events like needing dialysis or developing heavy protein in the urine. While there is a temporary initial dip in kidney filtration numbers, long-term outcomes are better than placebo. This is a standard-of-care option for kidney risk reduction in this specific high-risk group.
The incidence of the pre-specified main composite kidney endpoint... was lower with semaglutide (1.8%) versus placebo (2.2%): hazard ratio (HR) = 0.78; 95% confidence interval (CI) 0.63, 0.96; P = 0.02.
Why this rating
Large randomized controlled trial (n=17,604) with long follow-up (median 182 weeks) and pre-specified endpoints.
Source
Long-term kidney outcomes of semaglutide in obesity and cardiovascular disease in the SELECT trial
Helen M. Colhoun et al. · Nature Medicine · 2024
DOI 10.1038/s41591-024-03015-5
More from this paper
- Semaglutide 2.4 mg slows the rate of eGFR decline and reduces albuminuria (UACR) in patients with overweight/obesity, with greater benefits observed in those with baseline eGFR <60 ml/min/1.73m².Strong
- The kidney benefits of semaglutide are largely mediated by weight loss, although direct GLP-1 receptor effects on the kidney may also contribute.Good
Related findings · Hormonal
- Initial treatment for type 2 diabetes should be a combination of metformin and either an SGLT-2 inhibitor or a GLP-1 receptor agonist to achieve cardiorenal protection, rather than monotherapy or older agents like sulfonylureas.Strong
- For patients with specific monogenic obesity syndromes (leptin deficiency, POMC/PCSK1/LEPR mutations), targeted pharmacotherapy (recombinant leptin or setmelanotide) is highly effective and should be prioritized, unlike in polygenic obesity.Strong
- Continued weekly administration of 2.4 mg subcutaneous semaglutide prevents weight regain and promotes further weight loss in adults with overweight or obesity, whereas switching to placebo results in significant weight regain.Strong
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