Long-term kidney outcomes of semaglutide in obesity and cardiovascular disease in the SELECT trial

The SELECT trial previously reported a 20% reduction in major adverse cardiovascular events with semaglutide (n = 8,803) versus placebo (n = 8,801) in patients with overweight/obesity and established cardiovascular disease, without diabetes. In the present study, we examined the effect of once-weekly semaglutide 2.4 mg on kidney outcomes in the SELECT trial. The incidence of the pre-specified main composite kidney endpoint (death from kidney disease, initiation of chronic kidney replacement therapy, onset of persistent estimated glomerular filtration rate (eGFR) < 15 ml min⁻¹ 1.73 m², persistent ≥50% reduction in eGFR or onset of persistent macroalbuminuria) was lower with semaglutide (1.8%) versus placebo (2.2%): hazard ratio (HR) = 0.78; 95% confidence interval (CI) 0.63, 0.96; P = 0.02. The treatment benefit at 104 weeks for eGFR was 0.75 ml min⁻¹ 1.73 m² (95% CI 0.43, 1.06; P < 0.001) overall and 2.19 ml min⁻¹ 1.73 m² (95% CI 1.00, 3.38; P < 0.001) in patients with baseline eGFR < 60 ml min⁻¹ 1.73 m². These results suggest a benefit of semaglutide on kidney outcomes in individuals with overweight/obesity, without diabetes. ClinicalTrials.gov identifier: NCT03574597.