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Effect of semaglutide on kidney function across different levels of baseline HbA1c, blood pressure, body weight and albuminuria in SUSTAIN 6 and PIONEER 6

Apperloo, Ellen M, Cherney, David Z I, Kuhlman, Anja Birk, Mann, Johannes F E, Rasmussen, Søren, Rossing, Peter, Tuttle, Katherine R, Vrhnjak, Blaz, Heerspink, Hiddo J L·2025·Nephrology Dialysis Transplantation
DOI 10.1093/ndt/gfae150PMC PMC11792646
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Abstract

Background: This post hoc analysis explored the effects of semaglutide on estimated glomerular filtration (eGFR) slope by baseline glycemic control, blood pressure (BP), body mass index (BMI) and albuminuria status in people with type 2 diabetes and high cardiovascular risk. Methods: Pooled SUSTAIN 6 (Trial to Evaluate Cardiovascular and Other Long-Term Outcomes With Semaglutide in Subjects With Type 2 Diabetes) and PIONEER 6 (A Trial Investigating the Cardiovascular Safety of Oral Semaglutide in Subjects With Type 2 Diabetes) data were analyzed for change in eGFR slope by baseline hemoglobin A1c (HbA1c) (<8%/≥8%; <64/≥64 mmol/mol), systolic BP (<140/90/≥140/90 mmHg) and BMI (<30/≥30 kg/m2). SUSTAIN 6 data were analyzed by baseline urinary albumin:creatinine ratio (UACR; <30/30–300/>300 mg/g). Results: The estimated absolute treatment differences overall in eGFR slope (95% confidence intervals) favored semaglutide versus placebo in the pooled analysis [0.59 (0.29; 0.89) mL/min/1.73 m2/year] and in SUSTAIN 6 [0.60 (0.24; 0.96) mL/min/1.73 m2/year]; the absolute benefit was consistent across all HbA1c, BP, BMI and UACR subgroups (all P-interaction >.5). Conclusion: A clinically meaningful reduction in risk of chronic kidney disease progression was observed with semaglutide versus placebo regardless of HbA1c, BP, BMI, and UACR levels.

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Graphical Abstract CC BY-NC · PubMed Central
Figure 1: Analysis of eGFR slope by baseline HbA1c (A), BP (B), BMI (C) and UACR (D) subgroups (unadjusted*). Estimated treatment differences are shown at 1 year for HbA1c and BP subgroups, and at 1 and 2 years for the UACR subgroups. *Random slope model of repeated eGFR measures analyzed with eGFR value as dependent variable adjusted by baseline value, and time interacting with treatment and subgroup. Intercept and slopes of effect of time are assumed to vary randomly among individuals based on a two-dimensional normal distribution. CI, confidence interval; ETD, estimated treatment difference; geom., geometric; pinteraction, interaction P-value.
Figure 1: Analysis of eGFR slope by baseline HbA1c (A), BP (B), BMI (C) and UACR (D) subgroups (unadjusted*). Estimated treatment differences are shown at 1 year for HbA1c and BP subgroups, and at 1 and 2 years for the UACR subgroups. *Random slope model of repeated eGFR measures analyzed with eGFR value as dependent variable adjusted by baseline value, and time interacting with treatment and subgroup. Intercept and slopes of effect of time are assumed to vary randomly among individuals based on a two-dimensional normal distribution. CI, confidence interval; ETD, estimated treatment difference; geom., geometric; pinteraction, interaction P-value.CC BY-NC · PubMed Central
Figure 2: Analysis of eGFR slope by baseline HbA1c, BP and UACR, stratified by eGFR ≥30–<60 mL/min/1.73 m2 and ≥60 mL/min/1.73 m2 (unadjusted*). Estimated treatment differences are shown at 1 year for all subgroups. *Random slope model of repeated eGFR measures analyzed with eGFR value as dependent variable adjusted by baseline value, and time interacting with treatment and subgroup. Intercept and slopes of effect of time are assumed to vary randomly among individuals based on a two-dimensional normal distribution. CI, confidence interval; ETD, estimated treatment difference; pinteraction, interaction P-value.
Figure 2: Analysis of eGFR slope by baseline HbA1c, BP and UACR, stratified by eGFR ≥30–<60 mL/min/1.73 m2 and ≥60 mL/min/1.73 m2 (unadjusted*). Estimated treatment differences are shown at 1 year for all subgroups. *Random slope model of repeated eGFR measures analyzed with eGFR value as dependent variable adjusted by baseline value, and time interacting with treatment and subgroup. Intercept and slopes of effect of time are assumed to vary randomly among individuals based on a two-dimensional normal distribution. CI, confidence interval; ETD, estimated treatment difference; pinteraction, interaction P-value.CC BY-NC · PubMed Central
Figure 3: Analysis of eGFR slope by baseline HbA1c (A), BP (B), BMI (C) and UACR (D) subgroups (adjusted*). Estimated treatment differences are shown at 1 year for HbA1c and BP subgroups, and at 1 and 2 years for the UACR subgroups. *Adjusted for age, sex, diabetes duration, antidiabetes medication, smoking status, previous myocardial infarction/stroke/transient ischemic attack and geographic region. CI, confidence interval; ETD, estimated treatment difference; pinteraction, interaction P-value.
Figure 3: Analysis of eGFR slope by baseline HbA1c (A), BP (B), BMI (C) and UACR (D) subgroups (adjusted*). Estimated treatment differences are shown at 1 year for HbA1c and BP subgroups, and at 1 and 2 years for the UACR subgroups. *Adjusted for age, sex, diabetes duration, antidiabetes medication, smoking status, previous myocardial infarction/stroke/transient ischemic attack and geographic region. CI, confidence interval; ETD, estimated treatment difference; pinteraction, interaction P-value.CC BY-NC · PubMed Central

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Research works printed but not linked: 10

  1. American Diabetes Association Professional Practice Committee, 2022, 10. Cardiovascular disease and risk management: standards of medical care in diabetes—2022, Diabetes Care, 45, S144, 10.2337/dc22-S010 · DOI · Paper page
  2. Cherney, 2022, Hemoglobin A1c reduction with the GLP-1 receptor agonist semaglutide is independent of baseline eGFR: post hoc analysis of the SUSTAIN and PIONEER programs, Kidney Int Rep, 7, 2345, 10.1016/j.ekir.2022.07.167 · DOI
  3. Bain, 2019, Cardiovascular safety of oral semaglutide in patients with type 2 diabetes: rationale, design and patient baseline characteristics for the PIONEER 6 trial, Diabetes Obes Metab, 21, 499, 10.1111/dom.13553 · DOI
  4. Husain, 2019, Oral semaglutide and cardiovascular outcomes in patients with type 2 diabetes, N Engl J Med, 381, 841, 10.1056/NEJMoa1901118 · DOI · Paper page
  5. Levey, 2009, A new equation to estimate glomerular filtration rate, Ann Intern Med, 150, 604, 10.7326/0003-4819-150-9-200905050-00006 · DOI · Paper page
  6. Inker, 2023, A meta-analysis of GFR slope as a surrogate endpoint for kidney failure, Nat Med, 10.1038/s41591-023-02418-0 · DOI
  7. Rossing, 2023, The rationale, design and baseline data of FLOW, a kidney outcomes trial with once-weekly semaglutide in people with type 2 diabetes and chronic kidney disease, Nephrol Dial Transplant, 38, 2041, 10.1093/ndt/gfad009 · DOI · Paper page
  8. Mann, 2021, Potential kidney protection with liraglutide and semaglutide: exploratory mediation analysis, Diabetes Obes Metab, 23, 2058, 10.1111/dom.14443 · DOI · Paper page
  9. Yu, 2022, GLP-1 receptor agonists in diabetic kidney disease: current evidence and future directions, Kidney Res Clin Pract, 41, 136, 10.23876/j.krcp.22.001 · DOI
  10. Davies, 2021, Semaglutide 2.4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2): a randomised, double-blind, double-dummy, placebo-controlled, phase 3 trial, Lancet, 397, 971, 10.1016/S0140-6736(21)00213-0 · DOI · Paper page

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Metadata

Authors
Apperloo, E. M., Cherney, D. Z. I., Kuhlman, A. B., Mann, J. F. E., Rasmussen, S., Rossing, P., Tuttle, K. R., Vrhnjak, B., & Heerspink, H. J. L.
Affiliations
  • Department of Clinical Pharmacy & Pharmacology, University of Groningen, University Medical Center Groningen , Groningen ,
  • Division of Nephrology, Department of Medicine, University Health Network and University of Toronto , Toronto, ON ,
  • Novo Nordisk A/S , Søborg ,
  • KfH Kidney Center , Munich ,
  • Steno Diabetes Centre , Copenhagen ,
  • Providence Inland Northwest Health, University of Washington School of Medicine , Spokane ,
ORCID
Venue
Nephrology Dialysis Transplantation
Publisher
Oxford University Press (OUP)
Published
2024-07-02
Volume
40
Issue
2
Pages
352-359
ISSN
  • 0931-0509
  • 1460-2385
DOI
10.1093/ndt/gfae150
PMC
PMC11792646
Cited by
20
References
6
Language
en
Licence
creativecommons.org/licenses/by-nc/4.0/ (vor, 1 d)
Funders
Novo Nordisk

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