---
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
supports:
  - "glp 1 multi organ protection creates compounding value across kidney cardiovascular and metabolic endpoints"
reweave_edges:
  - "glp 1 multi organ protection creates compounding value across kidney cardiovascular and metabolic endpoints|supports|2026-03-31"
---

# 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


### Additional Evidence (confirm)
*Source: 2024-05-29-nejm-flow-trial-semaglutide-kidney-outcomes | Added: 2026-03-16*

FLOW trial (N=3,533, median 3.4 years follow-up) showed 24% reduction in major kidney disease events (HR 0.76, P=0.0003), with annual eGFR decline slowed by 1.16 mL/min/1.73m2 (P<0.001). Trial stopped early at prespecified interim analysis due to efficacy. FDA subsequently expanded semaglutide indications to include T2D patients with CKD. This is the first dedicated kidney outcomes trial with a GLP-1 receptor agonist, published in NEJM.


### Additional Evidence (confirm)
*Source: 2025-01-01-select-cost-effectiveness-analysis-obesity-cvd | Added: 2026-03-16*

SELECT trial economic model shows $2,074 per-subject lifetime savings from avoided CKD, supporting the claim that kidney protection generates substantial cost savings. However, diabetes prevention ($14,431) generates even larger savings.


### Additional Evidence (extend)
*Source: [[2025-06-01-value-in-health-comprehensive-semaglutide-medicare-economics]] | Added: 2026-03-18*

In the Medicare comprehensive model, CKD-related savings contribute $2,074 per subject treated, which is smaller than T2D savings ($14,431/subject) but still material. The 10-year modeling window may underestimate dialysis delay value since ESRD costs accumulate over longer periods. MASH savings were only $28M system-wide, suggesting treatment costs don't accumulate enough in the 10-year window to produce large offsets despite clinical efficacy.

---

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