- Yes, in people with type 2 diabetes and chronic kidney disease: in the FLOW trial of 3,533 adults, semaglutide lowered the risk of major kidney events or death from kidney or heart causes by 24% vs placebo.1
- On January 28, 2025, the FDA approved Ozempic to reduce kidney decline, kidney failure and heart death in this group.2
- The labels also warn that dehydration from vomiting or diarrhea can cause acute kidney injury. Kidney decisions belong with your care team.2,7
What was the FLOW trial?
FLOW was a randomized, double-blind trial funded by Novo Nordisk, which makes semaglutide (Ozempic, Wegovy). It enrolled 3,533 adults with type 2 diabetes and chronic kidney disease (CKD). To qualify, people needed reduced kidney function (an eGFR of 25 to 75) plus protein in the urine.1
Half got weekly semaglutide 1 mg and half got placebo, on top of usual care. At the start, mean age was 67, 70% were men, mean eGFR was 47, and 95% already took an ACE inhibitor or ARB blood pressure medicine. Only 16% took an SGLT2 inhibitor, another class shown to protect the kidneys.2 The trial was stopped early, at a planned interim check, because the benefit was clear. Median follow-up was 3.4 years.1
What did FLOW find?
The main outcome combined kidney failure, a drop in kidney function of at least 50%, and death from kidney or heart causes.
That is 331 vs 410 people, a 24% lower risk (hazard ratio 0.76).1,2 In absolute terms, about 4.5 fewer people out of every 100 had a main outcome event over roughly three and a half years.
| Outcome in FLOW | Semaglutide | Placebo | Hazard ratio |
|---|---|---|---|
| Main kidney and heart outcome | 18.7% | 23.2% | 0.76 |
| Kidney function down 50% or more | 9.3% | 12.1% | 0.73 |
| Started long-term dialysis or transplant | 4.9% | 5.7% | 0.84* |
| Death from heart causes | 7.0% | 9.6% | 0.71 |
| Heart attack, stroke or heart death | 12.0% | 14.4% | 0.82 |
| Death from any cause | 12.8% | 15.8% | 0.80 |
Kidney function also fell more slowly on semaglutide, by 1.16 mL/min/1.73 m² per year less than on placebo.1 Serious adverse events were reported in 49.6% of the semaglutide group and 53.8% of the placebo group.1
Some caveats from the label: the result was driven by fewer large drops in kidney function, progression to kidney failure and heart deaths. Kidney deaths were rare (5 in each group). And the benefit was not evident in people already taking an SGLT2 inhibitor, though there were few events in that group.2
Is Ozempic FDA-approved for kidney disease?
Yes, for adults with both type 2 diabetes and CKD. The FDA approved the new use on January 28, 2025.2 The Ozempic label's Indications section now includes reducing "the risk of sustained eGFR decline, end-stage kidney disease, and cardiovascular death in adults with type 2 diabetes mellitus and chronic kidney disease."2 We checked the current US labels for Wegovy, Zepbound and Mounjaro: none lists a kidney indication.7 For more on semaglutide in diabetes, see GLP-1 weight loss with type 2 diabetes.
What about people without diabetes? The SELECT kidney results
SELECT tested semaglutide 2.4 mg (Wegovy) in 17,604 adults with overweight or obesity and heart disease but no diabetes. Its main result was fewer heart attacks, strokes and heart deaths; see the SELECT heart trial. A prespecified secondary analysis looked at the kidneys.3
The kidney outcome, which also counted new heavy protein in the urine, occurred in 1.8% on semaglutide vs 2.2% on placebo. At 104 weeks, eGFR was 0.75 units better overall and 2.19 better in people who started with reduced kidney function.3 Most SELECT participants had normal kidneys, so events were uncommon. This is a secondary result, not the trial's main question.
A 2026 pooled analysis combined 30,787 people from SELECT, FLOW and SOUL (a trial of oral semaglutide). Kidney events, excluding heart deaths, occurred in 347 people on semaglutide vs 416 on placebo (hazard ratio 0.80).4 All three trials and the pooled analysis were funded by Novo Nordisk.
Does tirzepatide protect the kidneys?
There is no completed kidney-outcome trial of tirzepatide (Zepbound, Mounjaro) like FLOW yet. Two analyses from type 2 diabetes trials, both funded by Eli Lilly, point in a positive direction:
- SURPASS-4, post hoc analysis. In 2,002 adults with type 2 diabetes and high heart risk, eGFR fell by 1.4 per year on tirzepatide vs 3.6 on insulin glargine. A kidney composite outcome was less common on tirzepatide (hazard ratio 0.58). Post hoc means the question was asked after the trial ended, so treat it as a hint.5
- SURPASS-CVOT, prespecified exploratory analysis. In 13,165 adults with type 2 diabetes and heart disease, a kidney composite occurred in 6.0% on tirzepatide vs 7.6% on dulaglutide (Trulicity, another GLP-1), hazard ratio 0.77. The difference came mostly from fewer people developing heavy protein in the urine.6
Can semaglutide cause kidney problems?
The labels for Ozempic, Wegovy and Zepbound each include a warning, in Warnings and Precautions, about acute kidney injury due to volume depletion. They report postmarketing cases, some needing dialysis, mostly in people who became dehydrated from nausea, vomiting or diarrhea. The labels instruct clinicians to monitor kidney function in patients with these side effects, especially when starting or raising the dose.2,7 This is the label's instruction to prescribers, not advice for you. If you cannot keep fluids down, contact your care team. See also GLP-1 nausea and stomach side effects.
Kidney stones
The Wegovy label reports urolithiasis (stones in the urinary tract) in 1.2% of people on Wegovy vs 0.8% on placebo in its heart outcomes trial. Serious cases were 0.6% vs 0.4%.7 We did not find kidney stones listed in the Ozempic label.2
Common questions
Can semaglutide help with kidney disease?
In the FLOW trial of 3,533 adults with type 2 diabetes and chronic kidney disease, weekly semaglutide 1 mg (Ozempic) lowered the risk of major kidney events or death from kidney or heart causes by 24% compared with placebo over a median of 3.4 years. The trial did not study people without diabetes.
Is Ozempic approved for kidney disease?
Yes, for a specific group. On January 28, 2025, the FDA approved Ozempic to reduce the risk of sustained eGFR decline, end-stage kidney disease and cardiovascular death in adults with type 2 diabetes and chronic kidney disease, based on the FLOW trial. Wegovy, Zepbound and Mounjaro do not have a kidney indication.
What are the kidney benefits of Ozempic in numbers?
In FLOW, 18.7% of people on semaglutide had a major kidney event or died of kidney or heart causes, vs 23.2% on placebo. Deaths from any cause were 12.8% vs 15.8%, and kidney function declined more slowly, by 1.16 mL/min/1.73 m² per year.
Can semaglutide cause kidney problems?
The US labels for Ozempic and Wegovy warn about acute kidney injury, sometimes needing dialysis, mostly in people who became dehydrated from nausea, vomiting or diarrhea. They tell clinicians to monitor kidney function in people with these side effects, especially when starting or increasing the dose.
Does semaglutide cause kidney stones?
The Wegovy label reports urolithiasis (urinary stones) in 1.2% of people on Wegovy vs 0.8% on placebo in its heart outcomes trial in adults with obesity, with serious cases in 0.6% vs 0.4%. The Ozempic label does not list kidney stones.
Sources
- Perkovic V, Tuttle KR, Rossing P, et al. Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes. N Engl J Med. 2024;391(2):109-121. doi:10.1056/NEJMoa2403347 · PubMed
- US prescribing information for OZEMPIC (DailyMed; sections 1, 5.6, 14.3 and Table 10; checked November 2026). Approval of the kidney indication: Drugs@FDA, NDA 209637, supplement 25, January 28, 2025.
- Colhoun HM, Lingvay I, Brown PM, et al. Long-term kidney outcomes of semaglutide in obesity and cardiovascular disease in the SELECT trial. Nat Med. 2024;30(7):2058-2066. doi:10.1038/s41591-024-03015-5 · Full text (PMC)
- Mann JFE, Badve SV, Baeres FMM, et al. Effect of semaglutide on kidney outcomes in the SELECT, FLOW, and SOUL trials: a prespecified pooled analysis. Lancet Diabetes Endocrinol. 2026;14(10):818-830. doi:10.1016/S2213-8587(26)00134-8 · PubMed
- Heerspink HJL, Sattar N, Pavo I, et al. Effects of tirzepatide versus insulin glargine on kidney outcomes in type 2 diabetes in the SURPASS-4 trial: post-hoc analysis of an open-label, randomised, phase 3 trial. Lancet Diabetes Endocrinol. 2022;10(11):774-785. doi:10.1016/S2213-8587(22)00243-1 · PubMed
- Zoungas S, D'Alessio D, Pavo I, et al. A comparison of the effects of tirzepatide and dulaglutide on major kidney events in people with type 2 diabetes: pre-specified exploratory analyses of the SURPASS-CVOT trial. Lancet Diabetes Endocrinol. 2026;14(7):544-557. doi:10.1016/S2213-8587(26)00032-X · PubMed
- US prescribing information: WEGOVY (sections 1, 5.5 and 6.1), ZEPBOUND (sections 1 and 5.3) and MOUNJARO (section 1) (DailyMed; 2026 versions checked November 2026).
