FDA Approves Ozempic For Chronic Kidney Disease

Added: 2026-05-30

[00:00:00]trial of,533 people was stopped early. Now it wasn't stopped because something was wrong. The drug was working so well that leaving anybody on placebo was no longer ethical. That drug was ozen. And about 8 months later, the FDA approved it for a reason that has nothing to do with your bathroom scale. If you have diabetes and you've been watching your kidney numbers drift the wrong way for years, this is the trial you should have heard about by now. Welcome back to the channel everyone. I'm Dr. Sean Hashmi, board certified nefologist and obesity medicine specialist. Before we go further, please hit that subscribe button because I break down the kidney research the wellness internet won't touch and I do it every single week right here. So, here's what we've been fighting in diabetic kidney disease. The enemy is not your blood sugar number alone. It's the silent environment your kidneys have been bathing in for years.

[00:00:56]It's the high blood sugars. It's the high blood pressure. It's the lowgrade inflammation you just can't feel. Now, these environmental factors, they scar the filters inside your kidneys, one nefron at a time. And by the time your creatine moves on a lab report, you've already lost a huge chunk of function.

[00:01:17]For 20 years in my personal clinic, the conversation has gone the same way. Your kidney function is dropping. We can slow it, but we can't stop it. here's your ACE inhibitor and we'll see you back in 3 months. That conversation is over and let me show you why. The trial was called float. It was a phase and in it weekly simaglletide was given to adults with type 2 diabetes and chronic kidney disease. 533 people, 28 different countries and an average follow-up of about 3.4 years. Now, what's interesting is that everybody in the trial was already on standard care. That meant an ACE inhibitor or an ARB, oftentimes metformin, and sometimes SGLT2 inhibitors like jardians. This was the patient doing everything we had to offer and still losing kidney function every year we checked. The primary endpoint of the study was a composite of major kidney events. So, a sustained 50% or greater drop in EGFR, progression to kidney failure, dialysis or transplant, death from kidney causes, or death from cardiovascular causes. Now, when the data monitoring committee looked at the interim numbers in late 2023, the benefit was so clear they recommended stopping the study. Here's what they saw. Magide, it cut the composite kidney outcome by 24%.

[00:02:43]Albanura or protein in the urine dropped by 38%.

[00:02:47]And major adverse cardiovascular events like heart attack or stroke dropped by 18%.

[00:02:54]Most importantly, all cause mortality, the risk of dying dropped by 20%. Read that one again. People on saglletide in this trial were one in five less likely to die from any cause over 3 and 1/2 years. This is the first trial in my career where the tool did not just slow the loss, it changed the trajectory. So how is a weight loss drug doing this to the kidneys? Well, there are four mechanisms. Number one is glucose.

[00:03:24]Samagleide lowers blood sugar in a glucose dependent way. This results in less glycation, less oxidative stress, less damage to the small vessels feeding the kidney. Number two is weight.

[00:03:36]Patients lose roughly 10 to 15% of their body weight on higher doses. This means less visceral fat which means a smaller inflammatory load on every organ including the kidneys. Number three is pressure. There's modest blood pressure reduction and we also get natriesis.

[00:03:56]This is just a fancy kidney word for getting rid of extra salt in the urine that results in less force pushing on the inside of the filter. So far when we are looking at this, we have looked at some of the main mechanisms. But the fourth mechanism is where this drug truly becomes a kidneysaving drug and that is inflammation. So, if you've been watching diabetes content for years and wondering why does chasing the A1C with more insulin never seem to protect your kidneys, well, this is your answer.

[00:04:29]Insulin lowers the sugar, but it doesn't touch inflammation. And the scarring inside diabetic kidneys is driven by chronic low-grade inflammation that no glucoseing drug in our previous arsenal could ever touch. GLP1 receptors, they sit on immune cells, on the cells lining your blood vessels, on the cells inside the kidney itself, and activating them appears to dampen the slow burn that drives diabetic kidney scarring. In other words, you're not just lowering the heat from the outside the pot, you're turning down the burner. Quick pause, let me know in the comments below what your most recent kidney number is.

[00:05:09]Or if you don't know yet, just type I'm just watching. Remember, I want to understand where all of you are so I can create content that will help you. Now, one piece of clinical context that's really worth holding on to. The benefit of flow trial was stacked once again on top of ACE inhibitors and ARBs and SGLT2 inhibitors and the effects were additive. In other words, we are layering kidney protective therapies now. We're not choosing between them.

[00:05:40]And that's an amazing and incredible shift. The mechanism is real. The trial is solid. And the FDA has agreed. Now, sitting there with diabetes and watching your EGFR slide, what do you actually do this week? Let me give you four actionable steps in order. Step number one, pull up your last lab panel before your next appointment. You need two numbers. your kidney function or EGFR and your urine albamin to creatinine ratio sometimes called UACR. The flow trial enrolled adults with type 2 diabetes and an eGFR between 25 and 75 and they had elevated albamin in the urine. If your eGFR is between 50 and 75 and your urine albamin creatinine ratio is over 300, you want to have this conversation. On the other side, based on the study, if your eGFR was 25 to 50 and your urine albamin creatinine ratio was over 100, you want to have this conversation. Now if you don't have a urine album and creatinine ratio then this is the first thing you want to talk to your doctor about. Remember often times primary care doctor offices will skip it. If you have diabetes you want to make sure you are asking for the urine albamin creatinine ratio. Step number two is bring the trial up at your next visit. Not at a med spa. Once you know your numbers the next move is a conversation with your nephrologist or endocrinologist or primary care physician. You don't want to go to a compound version from a website. A specific ass always works better than a general one. Try this. I read about the flow trial in diabetic kidney disease.

[00:07:25]My EGFR is fill in the blank and my urine albim creatine ratio is fill in the blank. Am I a candidate for semaglutide for kidney protection? That sentence will change the visit. It puts you in the trial population. It names the indication and signals you've done your homework. Now, one firm contra indication to know before you ask. If you or a firstderee relative has a history of medularary thyroid carcinoma or multiple endocrine neuroplasia, then this drug is not for you. That's a hard stop, not a soft warning. Step number three is you want to build your sick day plan at the prescribing visit. If you start some magnetide, the side effect that matters most for your kidneys is dehydration. And so nausea, vomiting, diarrhea, constipation. If you can't keep fluids down for more than 24 hours while you're on this drug, you can spiral into acute kidney injury fast. So three sentences need to come out of that first visit. When do I hold the drug?

[00:08:29]When do I call the doctor's office? When do I go to the emergency room? Write the answers down. put them in your phone.

[00:08:36]The plan exists before you need it, not during. And finally, step number four is defend your muscle and track the right numbers. Remember, rapid weight loss on any drug cost you both fat and muscle.

[00:08:50]To skew the loss towards fat, two things have to be in place. Resistance training, two or three sessions a week, bands, machines, body weight, dumbbells.

[00:09:00]The drug does not build muscle for you.

[00:09:03]Adequate protein that is specific to your kidney stage. And remember, plant-based protein is the best. The exact target will depend on your kidney function. And it's the right question for your nephologist or a renal dietician. Don't Google it or freelance this one. Talk to the specialist. And then the numbers to track once you start are not your weight. They are your EGFR or kidney function, your albamin to creatinine ratio, your blood pressure and your 1C. Every 3 to 6 months depending on your stage, you want to get these tests done. Those are the signals that the drug is doing the job it was actually approved for. And this is also where the self-framework matters more, not less. Sleep matters because poor sleep blunts insulin sensitivity.

[00:09:52]Exercise matters because the drug does not build muscle for you. Love and connection matter because chronic stress drives the same inflammation the drug is fighting. And finally, a whole food plant-based diet matters because the kidneys still care what you put on that plate. Remember, the drug is a tool. It works best bolted onto sleep, exercise connection, and food, not instead of them. And here's the one thing to take away from this video. If you have type 2 diabetes and kidney disease, the flow data is the most important thing to have read before your next appointment. Bring it up. The answer might still be no for reasons that belong to you and your doctor, but the question has to be asked. I want to thank you guys so much for checking out this video. As always, please hit that like button, hit that share button, hit that subscribe button, share it with someone who thinks they might be going through these issues and might benefit from this. And as always, don't forget to practice kindness and gratitude.