---
type: claim
domain: health
description: "FLOW trial shows semaglutide slows kidney decline by 1.16 mL/min/1.73m2 annually in T2D patients with CKD, preventing dialysis progression that costs $90K+/year"
confidence: proven
source: "NEJM FLOW Trial (N=3,533, stopped early for efficacy), FDA indication expansion 2024"
created: 2026-03-11
---

# Semaglutide reduces kidney disease progression by 24 percent and delays dialysis onset creating the largest per-patient cost savings of any GLP-1 indication because dialysis costs $90K+ per year

The FLOW trial demonstrated that semaglutide reduces major kidney disease events by 24% (HR 0.76, P=0.0003) in patients with type 2 diabetes and chronic kidney disease over a median 3.4-year follow-up. The trial was stopped early at prespecified interim analysis due to efficacy — the effect was so large that continuing would have been unethical.

The mechanism of cost savings is slowed kidney function decline: semaglutide reduced the annual eGFR slope by 1.16 mL/min/1.73m2 compared to placebo (P<0.001). This slower decline delays or prevents progression to end-stage renal disease requiring dialysis, which costs $90,000+ per patient per year.

Kidney-specific outcomes showed HR 0.79 (95% CI 0.66-0.94), and cardiovascular death was reduced 29% (HR 0.71, 95% CI 0.56-0.89). The FDA subsequently expanded semaglutide (Ozempic) indications to include T2D patients with CKD, making this the first GLP-1 receptor agonist with a dedicated kidney protection indication.

CKD is among the most expensive chronic conditions to manage. The downstream savings argument for GLP-1s is strongest in kidney protection because preventing progression to dialysis has massive cost implications for capitated payers. A separate Nature Medicine analysis showed additive benefits when semaglutide is used with SGLT2 inhibitors.

This is the first dedicated kidney outcomes trial with a GLP-1 receptor agonist, establishing foundational evidence for the multi-organ benefit thesis.

## Evidence
- FLOW trial: N=3,533 patients, randomized controlled trial, median 3.4-year follow-up
- Primary endpoint: 24% risk reduction in major kidney disease events (HR 0.76, P=0.0003)
- Annual eGFR slope difference: 1.16 mL/min/1.73m2 slower decline (P<0.001)
- Cardiovascular death: 29% reduction (HR 0.71, 95% CI 0.56-0.89)
- Trial stopped early for efficacy at prespecified interim analysis
- FDA indication expansion to T2D patients with CKD (2024)
- Dialysis cost benchmark: $90K+/year per patient

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Relevant Notes:
- [[GLP-1 receptor agonists are the largest therapeutic category launch in pharmaceutical history but their chronic use model makes the net cost impact inflationary through 2035]]
- [[the healthcare cost curve bends up through 2035 because new curative and screening capabilities create more treatable conditions faster than prices decline]]

Topics:
- domains/health/_map