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ForumsSemaglutide (Ozempic / Wegovy)Semaglutide and GFR improvement — FLOW trial renal endpoints

Semaglutide and GFR improvement — FLOW trial renal endpoints

Dr.RenalNash Sat, Jun 6, 2026 at 9:15 PM 15 replies 218 viewsPage 1 of 3
Dr.RenalNash
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Jun 6, 2026 at 9:15 PM#1

This gets cited here weekly, usually second-hand, so it is worth setting out what it does and does not establish.

FLOW is the relevant trial and it reported a meaningful reduction in kidney-disease progression and related death in people with type 2 diabetes and chronic kidney disease. The mechanism looks to be a mixture of reduced albuminuria, better glycaemia and blood pressure, and a probable direct anti-inflammatory effect on the glomerulus. Separately, eGFR is genuinely noisy during rapid weight loss — a small early dip is common and usually haemodynamic rather than damage.

Where I think it is weakest: the subgroup findings are the part I trust least — with enough subgroups something is always significant, and these were not all pre-registered.

So the question, as narrowly as I can put it: how to read eGFR during rapid weight loss, given that creatinine depends on muscle mass and muscle mass is changing. Practical detail welcome, however dull — the duller the better.

Note on sourcing:
Figures above are from the primary publication rather than the press summary. If a number here disagrees with one you have, post yours and we will work out which of us is reading a secondary source.
23 18wei_SG, cory_ATX, lori_vegas and 20 others
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Dr.ReproEndo
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Jun 6, 2026 at 9:47 PM#2
Dr.RenalNash said:
FLOW is the relevant trial and it reported a meaningful reduction in kidney-disease progression and related death in people with type 2 diabetes and…

That holds for the injectable. The oral formulation has different absorption behaviour and the dose numbers are not interchangeable, which is worth saying out loud because people quote them as if they were.

Last edited: Jun 6, 2026 at 10:47 PM
22 17andrew_nyc, Dr.EndoEP, GraceAZ_72 and 19 others
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VendorMark
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Jun 6, 2026 at 10:19 PM#3
Dr.RenalNash said:
FLOW is the relevant trial and it reported a meaningful reduction in kidney-disease progression and related death in people with type 2 diabetes and…

I will push back on the "any working dose is fine" framing. The maintenance evidence sits overwhelmingly at the top studied dose, and the extension data shows regain tracking dose reduction rather than tracking stopping. Holding low is reasonable; pretending it is evidentially equivalent is not.

Last edited: Jun 7, 2026 at 12:19 AM
21 16MarkLI_maint, Dr.PeteFamMed, claudia_zurich and 18 others
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paige_pharma
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Jun 6, 2026 at 10:51 PM#4

Answering the narrow version, because the broad one does not have a single answer. Albumin binding above 99% is the whole reason weekly dosing works, and it is also why the trough matters more than the peak. People who dose late are not losing a peak, they are letting the trough fall, and the appetite effect tracks the trough.

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patPC_UT
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Jun 7, 2026 at 1:56 AM#5
Dr.ReproEndo said:
The oral formulation has different absorption behaviour and the dose numbers are not interchangeable, which is worth saying out loud because people…

Agreed, though "tolerable" needs defining. A dose you tolerate by eating almost nothing is not tolerated, it is being paid for somewhere else — usually in lean mass, sometimes in adherence three months later.

19 14julia.endo, JessicaM_2024, TomFromTexas and 16 others
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