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

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. Graphical Abstract