The SELECT (Semaglutide effects on heart disease and stroke in patients with overweight or obesity) trial has revealed the potential of semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, in combating kidney function decline among overweight or obese individuals with established cardiovascular disease but without diabetes.
Unveiling the results at the 61st European Renal Association (ERA) congress (23–26 May, Stockholm, Sweden), researchers presented the secondary analysis from the SELECT trial, a randomised trial comprising a participant pool of 17,604 individuals.
They stated that experts believe the study’s results offer hope for those affected by obesity, a condition known to exacerbate the risk of kidney function decline and macroalbuminuria (abnormal amounts of the albumin protein in urine).
The study had an average follow-up of approximately 3.5 years and looked at patients who received a once-weekly subcutaneous injection of semaglutide (2.4mg). According to the authors, adverse kidney-related events were experienced by 22% fewer persons (1.8%) compared to those receiving placebo (2.2%). These events included death from kidney causes, initiation of chronic kidney replacement therapy, significant (≥50%) decline in kidney function, or onset of persistent macroalbuminuria. The researchers highlighted semaglutide’s ability to prevent the onset of macroalbuminuria as a key factor in reducing the likelihood of kidney-related complications.
The study also assessed the impact of semaglutide on estimated glomerular filtration rate (eGFR). The findings indicated a significantly reduced decline in eGFR among semaglutide recipients compared to the placebo group, with the effect being more pronounced in participants with baseline eGFR below 60mL/ min/1.73m².
These results indicate the potential for semaglutide to particularly protect kidney function in individuals with a pre-existing kidney impairment, a press release says.
The authors stated that the reduction in urinary albumin-to-creatinine ratio (UACR) further substantiated the beneficial effect of semaglutide on kidney health, with a significant decrease observed in semaglutide-treated individuals compared to placebo. With semaglutide, there was a net 8.1% decrease in UACR in those with normal albumin levels at baseline, a 27.2% decrease in those with microalbuminuria (slightly raised albumin) at baseline, and a 31.4% decrease in those with macroalbuminuria at baseline relative, to placebo.
An important aspect of the study that was highlighted was that it found no increased risk of acute kidney injury (AKI) associated with semaglutide treatment, irrespective of baseline kidney function.
According to the researchers, over one billion people worldwide are affected by obesity and rates of obesity are rising significantly, having doubled among adult women (8.8–18.5%) and nearly tripled in adult men (4.8– 14%) between 1990 and 2022. The total number of children affected by obesity in 2022 was nearly 160 million, compared to 31 million in 1990.
Helen M Colhoun (Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK), lead study author, stated: “By addressing key markers of kidney health, semaglutide 2.4mg weekly may contribute to a significant reduction in the risk of kidney-related complications, including chronic kidney disease and end-stage renal disease. This could lead to improved management of comorbidities and, ultimately, enhance the quality of life for individuals with obesity.”
Continuing, she added that “the observed benefits in eGFR and UACR are particularly encouraging, suggesting potential for the enhanced management of kidney complications in the overweight and obese patients without diabetes. The findings also underscore the importance of continued research into the possible renal benefits of semaglutide and highlight its role as a promising therapeutic option in the multifaceted management of cardiovascular and renal health in this high-risk population.”
