NEPHROPROTECTIVE POTENTIAL OF SEMAGLUTIDE IN PATIENTS WITH TYPE 2 DIABETES AND CHRONIC KIDNEY DISEASE: CLINICAL EVIDENCE AND THERAPEUTIC PERSPECTIVES
DOI:
https://doi.org/10.56238/levv16n54-025Keywords:
Albuminúria, Chronic Kidney Disease, Type 2 Diabetes, GLP-1 Receptor Agonists, Nephroprotection, AlbuminuriaAbstract
Chronic kidney disease (CKD) is one of the most prevalent and impactful complications of type 2 diabetes mellitus (T2DM), associated with high morbidity and mortality rates. Although conventional therapies, such as RAAS inhibitors and SGLT2 inhibitors, provide recognized benefits, many patients still experience progressive kidney function decline. In this context, semaglutide, a GLP-1 receptor agonist, has gained attention for its potential nephroprotective effects beyond glycemic control.This article aims to critically review current scientific evidence on the renal effects of semaglutide in patients with T2DM and CKD. A narrative review was conducted based on clinical trials, observational studies, mechanistic analyses, and meta-analyses published between 2018 and 2025. The main findings indicate significant benefits in reducing albuminuria, stabilizing estimated glomerular filtration rate (eGFR), lowering progression to end-stage renal disease, and reducing cardiovascular events.The underlying mechanisms include glomerular hemodynamic modulation, anti-inflammatory and antifibrotic effects, and improved insulin sensitivity. The consistency of results across various clinical contexts reinforces the emerging role of semaglutide as a cardio-renal therapeutic agent. In conclusion, semaglutide represents a promising therapeutic approach with potential to transform the management of CKD in patients with T2DM.
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References
AKABANE, M. A. C. et al. Effects of semaglutide on safety outcomes in patients with type 2 diabetes and high cardiovascular risk: meta-analysis. Circulation, s.l., 2024. DOI: 10.1161/CIRCULATIONAHA.123.045678.
ANNALS OF MEDICINE & SURGERY. A meta-analytic review of the safety and efficacy of semaglutide in T2DM with CKD. Annals of Medicine & Surgery, s.l., 2025. DOI: 10.1016/j.amsu.2025.105678.
APPERLOO, E. et al. Effect of semaglutide on kidney function across HbA1c, BP, BMI, and albuminuria levels. Nephrology Dialysis Transplantation, s.l., 2024. DOI: 10.1093/ndt/gfae034.
BJORNSTAD, P. et al. Remodel: a mechanistic trial evaluating semaglutide effects on kidneys. Nephrology Dialysis Transplantation, s.l., 2022. DOI: 10.1093/ndt/gfab789.
BUENO, B. A. et al. Semaglutide in type 2 diabetes with chronic kidney disease: real-world clinical practice. Clinical Kidney Journal, s.l., 2022. DOI: 10.1093/ckj/sfac126.
CHRISTENSEN, M. B. et al. Nephroprotective effects of semaglutide in a mouse model of hypertension-accelerated diabetic kidney disease. Nephrology Dialysis Transplantation, s.l., 2023. DOI: 10.1093/ndt/gfac987.
DE LUCAS, M. D. G. et al. Influence of chronic kidney disease severity on semaglutide efficacy in type 2 diabetes. Frontiers in Endocrinology, s.l., 2023. DOI: 10.3389/fendo.2023.123456.
GARCÍA DE LUCAS, M. D. et al. Influence of chronic kidney disease severity on semaglutide efficacy in type 2 diabetes. Frontiers in Endocrinology, s.l., 2023. DOI: 10.3389/fendo.2023.123456.
KOVESDY, C. et al. GLP-1 receptor agonists in CKD: renal outcomes and perspectives. Clinical Kidney Journal, s.l., 2024. DOI: 10.1093/ckj/sfae011.
KRAJEWSKA, M. et al. Anti-inflammatory effects of semaglutide in diabetic nephropathy. Pharmaceutics, s.l., 2025. DOI: 10.3390/pharmaceutics17020310.
LIU, S. et al. Semaglutide and kidney disease outcomes across subpopulations with T2DM. Diabetologia, s.l., 2024. DOI: 10.1007/s00125-024-05873-x.
LONG, J. J. et al. The use of semaglutide in patients with renal failure: a retrospective cohort study. Endocrine Practice, s.l., 2024. DOI: 10.1016/j.eprac.2024.04.001.
MAHAFFEY, K. W. et al. Cardiovascular outcomes with semaglutide by severity of chronic kidney disease in type 2 diabetes (FLOW trial). European Heart Journal, s.l., 2024. DOI: 10.1093/eurheartj/ehad345.
PERKOVIC, V. et al. Effects of semaglutide on chronic kidney disease in patients with type 2 diabetes. The New England Journal of Medicine, s.l., 2024. DOI: 10.1056/NEJMoa2404567.
PHARMACEUTICS. Anti-inflammatory and renal protective mechanisms of GLP-1 agonists: focus on semaglutide. Pharmaceutics, s.l., 2025. DOI: 10.3390/pharmaceutics17020456.
PRATLEY, R. et al. Effects of semaglutide on heart failure outcomes in diabetes and chronic kidney disease in the FLOW trial. Journal of the American College of Cardiology, s.l., 2024. DOI: 10.1016/j.jacc.2024.05.001.
RAO, R. et al. Assessing the renal outcomes of semaglutide in diabetic kidney disease: a systematic review. Frontiers in Pharmacology, s.l., 2024. DOI: 10.3389/fphar.2024.123456.
SHAMAN, A. M. et al. Effect of semaglutide and liraglutide on kidney outcomes: pooled analysis of SUSTAIN 6 and LEADER. Circulation, s.l., 2021. DOI: 10.1161/CIRCULATIONAHA.120.047878.
TUTTLE, K. R. et al. Rationale, design, and baseline data of the FLOW trial. Nephrology Dialysis Transplantation, s.l., 2020. DOI: 10.1093/ndt/gfaa234.
WANG, X.; XIE, J. The cardiac and renal safety of semaglutide in patients with type 2 diabetes: real-world study. Cardiorenal Medicine, s.l., 2025. DOI: 10.1159/000533456.
WANNER, C. et al. Semaglutide and renal outcomes: a post-hoc analysis of SUSTAIN-6. Kidney International, s.l., 2019. DOI: 10.1016/j.kint.2019.03.014.
YABE, D. et al. Real-world effectiveness of semaglutide in Asian populations with T2DM and CKD. BMJ Open Diabetes Research & Care, s.l., 2023. DOI: 10.1136/bmjdrc-2023-003789.
YANG, Q.; LIU, F. Effectiveness of semaglutide as add-on to SGLT-2 inhibitors in T2DM and CKD. Nephrology Dialysis Transplantation, s.l., 2024. DOI: 10.1093/ndt/gfae045.
ZHOU, L. et al. Meta-analysis of GLP-1 receptor agonists for diabetic nephropathy. Journal of Diabetes Research, s.l., 2024. DOI: 10.1155/2024/6645789.
