I've been tracking my kidney function obsessively since starting semaglutide 14 months ago. Background: T2D for 8 years, mild diabetic kidney disease (CKD stage 2-3a), was on max dose ACE inhibitor. The FLOW trial data was what convinced my nephrologist to add semaglutide. Here are my results: | Marker | Baseline (Oct 2024) | 6 Months | 12 Months | 14 Mo (Now) | Goal | |--------|-------------------|----------|-----------|-------------|------| | eGFR | 52 mL/min | 48 mL/min | 56 mL/min | 58 mL/min | >60 | | Creatinine | 1.24 mg/dL | 1.31 mg/dL | 1.18 mg/dL | 1.14 mg/dL | <1.2 | | UACR | 186 mg/g | 124 mg/g | 82 mg/g | 68 mg/g | <30 | | BUN | 28 mg/dL | 26 mg/dL | 22 mg/dL | 20 mg/dL | 6-24 | | Cystatin C | 1.42 mg/L | 1.38 mg/L | 1.18 mg/L | 1.12 mg/L | 0.6-1.0 | A few things to note: 1. eGFR DIPPED at 6 months before improving — this is the hemodynamic effect documented in FLOW (like SGLT2 inhibitors) 2. UACR dropped 63% — this is the big one. Albuminuria reduction is the strongest predictor of kidney protection. 3. I'm almost back to CKD stage 2 from stage 3a. My nephrologist is genuinely excited. Anyone else tracking kidney function?

your results are incredible and very consistent with what we're seeing in clinical practice post-FLOW trial. Let me explain the eGFR dip for others: The initial eGFR dip is actually a GOOD sign. Both GLP-1 RAs and SGLT2 inhibitors reduce intraglomerular pressure (the pressure inside the kidney's filtering units). This initially causes eGFR to drop by 3-8 mL/min because the kidney is filtering less aggressively — but this reduced pressure is what PROTECTS the kidney long-term. Think of it like a fire hose being turned down from "blast" to "steady stream." Less volume per minute, but much less damage to the delicate filtering membranes. The FLOW trial showed: - 24% reduction in kidney disease progression - 21% reduction in eGFR decline over time - Significant albuminuria reduction Your UACR going from 186 to 68 mg/g is the most meaningful number here. You're trending toward the normal range (<30).

This gives me hope. I'm CKD stage 3b (eGFR 38) with T2D. My nephrologist has been hesitant about GLP-1 therapy because of my kidney function. She's worried about dehydration and GI side effects worsening kidney function. Any thoughts? Current labs: - eGFR: 38 mL/min - UACR: 320 mg/g - Creatinine: 1.68 mg/dL - A1c: 7.4% On lisinopril 40mg, dapagliflozin 10mg, metformin 1000mg (reduced from 2000 due to eGFR).

Ron, your nephrologist's caution is reasonable but the data supports GLP-1 use in CKD3b. Key points: 1. Semaglutide does NOT require dose adjustment for kidney function — it's metabolized by proteolysis, not renally cleared 2. The FLOW trial included patients with eGFR as low as 25 and showed benefit across all CKD stages 3. The dehydration concern is valid — GI side effects (nausea, vomiting, diarrhea) can cause volume depletion which is risky in CKD. Slow titration is critical. 4. Your combination of ACEi + SGLT2i + GLP-1 RA is actually the emerging "triple therapy" for diabetic kidney disease. It addresses three separate pathological mechanisms. I'd suggest asking for a referral to a nephrologist who is familiar with the FLOW trial data. The evidence is now quite strong.

Ron, I was in a similar boat — eGFR in the low 50s and my nephrologist was initially cautious too. What convinced her was the FLOW trial results and the fact that I was very compliant with hydration. I drink at minimum 80-100 oz of water daily and I started at the lowest semaglutide dose with very slow titration (stayed at 0.25 mg for 8 weeks instead of 4). The nausea was minimal with slow titration and my kidney function has only improved. Obviously everyone is different, but the data is really compelling for kidney protection.