A popular diabetes medication has been found to prevent kidney failure and reduce deaths in people with type 2 diabetes and chronic kidney disease.
Antidiabetic medication semaglutide, more widely known by brand names Ozempic and Wegovy, significantly reduces the risk of kidney failure, substantial loss of kidney function and death from kidney or cardiovascular causes, an international clinical trial led by UNSW Sydney researchers has shown.
The trial involving more than 3500 participants with type 2 diabetes and chronic kidney disease from 28 countries – including Australia, the USA and China – found a small weekly dose of semaglutide reduced the risk of major kidney events by 24 per cent.
The risk of cardiovascular events such as heart attack and stroke was also 18 per cent lower for those on semaglutide, which was given to half of the participants in the placebo-controlled trial, while risk of death from any cause was 20 per cent lower, says .
Lead study author and Scientia Professor Vlado Perkovic, Provost at UNSW Sydney, said the benefits of semaglutide for those with type 2 diabetes and chronic kidney disease were greater than expected.
“We would be saving kidneys, hearts and lives in this population by making this drug available to them and that’s quite extraordinary for one treatment to be able to do,” Prof. Perkovic, a nephrologist, said.
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The trial, conducted between June 2019 and May 2021, used a lower dose of semaglutide than generally used for diabetes or weight loss treatment, with patients receiving 1.0 mg per week or a placebo. The trial was funded by pharmaceutical company Novo Nordisk, the supplier of Ozempic.
Semaglutide also slowed down loss of kidney function, lowered systolic blood pressure, and reduced body weight among participants.
Serious adverse effects were also less common, compared to those experienced by the placebo group, but were still experienced by almost 50 per cent of those on semaglutide, which Prof. Perkovic said was a function of the poor health of those involved in the trial – people with high-risk chronic kidney disease.
The proven benefits prompted the trial to be cut short, based on a recommendation by an Independent Data Monitoring Committee.
“It’s the same chemical compound but we used a lower dose ... we did that deliberately because people with kidney disease tend to be more sensitive to the effects and side effects of drugs,” Prof. Perkovic said.
“That’s helpful in terms of being able to perhaps have the drug more widely used than might have otherwise been the case given the current supply limitations.”
Kidney disease on the rise
It’s hoped the findings could soon help the growing number of people with kidney disease, which now affects about 850 million people worldwide, Prof. Perkovic said.
“One of the most common causes of kidney disease is diabetes, particularly type 2 diabetes, which has also been growing dramatically in recent decades,” he said.
Chronic kidney diseased contributed to about 20,000 deaths in Australia in 2021, about 12 per cent of all deaths that year, the latest for which figures from the are available.
In addition to loss of kidney function, kidney disease increases the risk of a range of other health conditions, particularly heart disease and stroke, and is associated with poorer quality of life.
“People with kidney disease feel tired, weak and a bit foggy-headed, they often can't think clearly, and their quality of life is therefore dramatically reduced,” Prof. Perkovic said.
“If they end up on dialysis it affects not just them but their family, because they have to go off and have dialysis several times a week and ... the cost of dialysis is really expensive, it's $100,000 per person per year in Australia or more.”
The challenges ahead for kidney disease
Prof. Perkovic said there has been an increase in treatments for chronic kidney disease in recent years, but more needed to be done.
“We're really starting to dramatically improve outcomes for people with diabetes and kidney disease. But that will only happen if the results are translated into action at the clinical coalface, so that's an important next step,” he said.
That will require overcoming supply shortages for semaglutide and the general lag in implementing research in clinical settings. More research is also needed to determine the optimal way to use semaglutide in combination with other existing treatments.
“The challenge is to get these results into clinical practice, to get the drug used by the people who will benefit from it, who will live longer without dialysis, without heart attacks, without strokes, if they take this drug.”
Novo Nordisk will need to seek regulatory approval for semaglutide to be used to treat those with chronic kidney disease. Prof. Perkovic expected this would be granted, and that semaglutide would become part of guideline-based therapy.
