# FLOW Trial: Semaglutide 1.0 mg in Diabetic Chronic Kidney Disease | This GLP The FLOW trial randomized 3,533 people with type 2 diabetes and chronic kidney disease to semaglutide 1.0 mg or placebo and found a hazard ratio of 0.76 for major kidney events. Publisher: This GLP Editorial Team Canonical: https://thisglp.com/research/semaglutide-and-kidney-disease Updated: 2026-09-18 Published: 2026-09-15 [← Research](https://thisglp.com/research) Evidence # FLOW Trial: Semaglutide 1.0 mg in Diabetic Chronic Kidney Disease A 24 percent reduction in major kidney events, with every secondary outcome agreeing, in a trial stopped early at an interim analysis. The dose was 1.0 mg, the diabetes dose, not the one sold for weight loss. [This GLP Editorial Team](https://thisglp.com/about)September 20266 min readUpdated September 2026 FLOW: hazard ratios against placebo · 1.0 · Major kidney events · 0.76 · Cardiovascular death · 0.71 · Major cardiac events · 0.82 · Death from any cause · 0.80 **Research, not medical advice.** This GLP is independent and educational. Nothing here is a substitute for individualized care from a licensed clinician, and reading it creates no doctor–patient relationship. Talk to your own provider before starting, stopping, or changing any medication, peptide, or therapy. See our [methodology](https://thisglp.com/methodology) and [terms](https://thisglp.com/terms). FLOW is the trial that stopped early because it was working. It randomized 3,533 people with type 2 diabetes and chronic kidney disease to semaglutide 1.0 mg weekly or placebo, and an interim analysis recommended cessation before the planned end, after a median follow-up of 3.4 years [\[1\]](https://thisglp.com/research/semaglutide-and-kidney-disease#ref-1). The result is one of the strongest in this drug class, and it comes with a condition almost nobody mentions when quoting it — a condition that matters before you compare [what any seller charges](https://thisglp.com/best). ## What it found The primary outcome was a composite of kidney failure, a 50 percent or greater fall in eGFR, or death from kidney or cardiovascular causes. Risk was 24 percent lower on semaglutide, at 331 first events against 410, a hazard ratio of 0.76 (95% CI 0.66 to 0.88, P = 0.0003). Every confirmatory secondary outcome moved the same way. The kidney-specific composite was 0.79 (95% CI 0.66 to 0.94). Death from cardiovascular causes was 0.71 (95% CI 0.56 to 0.89). Major cardiovascular events were 18 percent lower at 0.82 (95% CI 0.68 to 0.98), and death from any cause 20 percent lower at 0.80 (95% CI 0.67 to 0.95). The mean annual eGFR slope was less steep by 1.16 ml per minute per 1.73 m². Serious adverse events were reported in fewer participants on the drug than on placebo, 49.6 percent against 53.8. ## The condition on all of it The dose was 1.0 mg weekly. That is the type 2 diabetes dose, and it is not the 2.4 mg weight-management dose that most compounded semaglutide sold online is titrated toward. The population was people with diabetes and established kidney disease, defined by specific eGFR and albumin-to-creatinine thresholds — not a general weight-loss population. None of that makes the result less real. It means the result belongs to a drug at a dose in a population, and moving it onto a different dose in a different population is an assumption rather than a finding. If a seller’s page cites kidney benefits, the question to ask is which trial and at what dose — and most sellers publish nothing about dose at all, which we have counted in [who publishes a dose ladder](https://thisglp.com/research/who-publishes-a-glp1-dose-ladder). ## Why early cessation is worth understanding Stopping a trial early for benefit is the right thing to do for the participants and it systematically inflates effect estimates, because trials stop at a moment when the data happen to look good. The effect here is large, consistent across every secondary outcome, and prespecified — which is about as reassuring as an early stop gets. It is still a reason to expect the real-world effect to be somewhat smaller. For anyone with kidney disease considering a telehealth purchase, the practical gap is not the evidence. It is that this is a condition requiring monitoring, and most of the sellers tracked here publish nothing about who reviews a case or how often — a census we keep in [what sellers publish](https://thisglp.com/tools/what-sellers-publish) and in [what they will not tell you](https://thisglp.com/research/what-glp1-sellers-do-not-publish). ## Frequently asked How much did semaglutide reduce kidney events? By 24 percent against placebo — 331 first events against 410, a hazard ratio of 0.76 (95% CI 0.66 to 0.88) over a median 3.4 years. Does this apply to the dose I would be sold? Not directly. FLOW used 1.0 mg weekly, the type 2 diabetes dose. Most compounded semaglutide sold online is titrated toward the 2.4 mg weight-management dose. Why did the trial stop early? A prespecified interim analysis recommended cessation for benefit. That is correct for participants and it tends to inflate effect estimates, so expect the real-world effect to be somewhat smaller. ## Sources 1. \[1\] Perkovic V, et al. (2024). Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes New England Journal of Medicine. [PMID 38785209](https://pubmed.ncbi.nlm.nih.gov/38785209/) ## Where to get it ### Best GLP-1 injections Every injectable seller we can verify, with the price each one publishes and an honest read of what the trials measured. [Compare providers →](https://thisglp.com/best/compounded-semaglutide) ## More in Evidence - [ 150 minutes · Weekly activity goal · 2 days · Muscle strengthening · Adapt · Symptoms and ability ### Exercise on Ozempic: Building Strength Without Ignoring Symptoms ](https://thisglp.com/research/exercise-on-ozempic) - [ STEP 1, semaglutide 2.4 mg vs placebo, % change at 68 weeks · LDL cholesterol · −2.5% vs +1.3% · Total cholesterol · −3.3% vs +0.1% · HDL cholesterol · +5.2% vs +1.4% · Triglycerides · −21.9% vs −7.3% · Wegovy label, Table 13. Adults without diabetes. Ozempic doses are lower. ### Does Ozempic Lower Cholesterol? 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