Management of hyperglycemia in patients with advanced chronic kidney disease (CKD) remains challenging because treatment options are often limited by safety concerns and reduced kidney function. Findings presented at the ADA Scientific Sessions 2026 evaluated the safety and efficacy of semaglutide in patients with type 2 diabetes mellitus (T2DM) and CKD stages 4-5.

This retrospective analysis included 45 patients with T2DM and advanced CKD who initiated semaglutide and were followed for 12 months. Primary endpoints included changes in glycated hemoglobin (HbA1c) and estimated glomerular filtration rate (eGFR) from baseline to the last available follow-up. Secondary endpoints included changes in body weight, body mass index (BMI), safety outcomes, and discontinuation rates. Paired analyses were performed using the Wilcoxon signed-rank test.

Findings

• Mean age was 69.1 ± 10.9 years, and 57.8% of patients were female.
• Baseline HbA1c was 8.3 ± 1.7%, baseline eGFR was 25.5 ± 10.2 mL/min/1.73 m², and baseline weight was 77.6 ± 16.6 kg.
• Semaglutide reduced HbA1c by 0.71% during follow-up (P<0.001).
• Kidney function remained stable, with no significant change in eGFR (Δ −0.22 mL/min/1.73 m²; P=0.305).
• Weight decreased by −0.43 kg, although the change was not statistically significant (P=0.496).
• The discontinuation rate was 13.3%, primarily due to gastrointestinal adverse events.

This analysis showed that semaglutide improved glycemic control while maintaining stable kidney function in patients with T2DM and CKD stages 4-5. The safety profile was generally consistent with previous GLP-1 receptor agonist experience, although larger prospective studies are needed to further evaluate efficacy and tolerability in advanced CKD populations.