Why the study?
Contemporary CKD guidelines increasingly support GLP-1RAs as part of cardiorenal therapy, but practical clinical considerations and prescribing strategies for semaglutide in T2D-CKD in Australia are needed.
Effect estimate: 24% reduction
This consensus statement translates recent trial evidence into practical, implementable prescribing strategies for the use of semaglutide in Australian patients with type 2 diabetes and chronic kidney disease.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“It's great to see the expansion, but it may not necessarily change patients' access under the PBS. So, for GPs, it's good to know, but may not change GP prescribing habits at this stage. [Semaglutide] in the international guidelines is a suggested additional therapy for the management of chronic kidney disease. However, despite being in the evidence-based guidelines, the PBS is not currently supportive of that, according to the funding arrangements.”
“There's no doubt that both cost and availability present a barrier to the more widespread use of semaglutide at the moment. But I'm sure that over time that situation will change and the drugs will become more widely available.”
“Patients are increasingly requesting Ozempic by name, often prompted by media exposure or counseling from primary care providers about a medication that may help protect kidney function.”
Supports semaglutide incorporation into T2D-CKD cardiorenal regimens; provides first kidney-outcome data for any GLP-1RA.
Chronic kidney disease (CKD) and cardiovascular disease (CVD) are major causes of morbidity and mortality in people with type 2 diabetes (T2D). Contemporary CKD guidelines increasingly support incorporation of glucagon-like peptide-1 receptor agonists (GLP-1RAs) as an additional pillar of cardiorenal therapy alongside renin-angiotensin-aldosterone system (RAAS) blockade, sodium-glucose co-transporter 2 inhibitors (SGLT2i) and finerenone. Semaglutide is the first GLP-1RA with kidney-outcome data from a dedicated trial in T2D-CKD: the Evaluate Renal Function with Semaglutide Once Weekly (FLOW) study. In FLOW, once-weekly subcutaneous semaglutide 1 mg reduced major kidney disease events by 24%, major adverse cardiovascular events by 18% and all-cause mortality by 20% versus placebo on a background of guideline-directed therapy. Here a multidisciplinary expert panel summarises Australian Therapeutic Goods Administration indications and Pharmaceutical Benefits Scheme restrictions, highlights common access barriers and outlines approaches to shared care between primary and tertiary services for use of GLP-1RAs. Guidance is also provided on treatment sequencing of GLP-1RA alongside RAAS blockade, SGLT2i and finerenone. Evidence from key GLP-1RA trials, in addition to FLOW, is reviewed and translated into practical, implementable prescribing strategies for Australian clinicians. The panel also identified priority patient groups for GLP-1RA therapy, including those with residual albuminuria, heart failure with preserved ejection fraction, established CVD, obesity and Aboriginal and Torres Strait Islander peoples at high cardiorenal risk. Remaining evidence gaps, particularly for non-diabetic CKD, advanced CKD, dialysis and transplant populations and equity of access, are identified as priorities for future research and policy.
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Pedagogos et al. (2026) conducted a review in Type 2 diabetes and chronic kidney disease. Semaglutide vs. Placebo was evaluated on Major kidney disease events (24% reduction). A multidisciplinary panel reviewed evidence for GLP-1RAs in type 2 diabetes and chronic kidney disease, highlighting that semaglutide reduced major kidney disease events by 24% in the FLOW trial.
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