Background Semaglutide (glucagon-like peptide-1 receptor-agonist, GLP-1RA) has shown nephroprotective effects in previous cardiovascular studies. However its efficacy and safety in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) has been scarcely studied. Materials and methods this is a multicenter, retrospective, observational study in patients with T2D and CKD with A1c glycosylated haemoglobin (HbA1c) between 7.5-9.5% treated with subcutaneous semaglutide for 12 months in real-world clinical practice. Main objectives were glycemic control as HbA1c<7% and weight loss of >5%. Results 122 patients, age 65.50±11years, 62% men. Duration of T2D: 12 years and baseline HbA1c: 7.57%±1.36%, eGFR: 50.32±19.21 ml/min/1.73m2; 54% had albumin-to-creatinine ratio (UACR):30-300 mg/g and 20% UACR >300 mg/g. After 12 months of follow up: HbA1c declined -0.73%±1.09%(p<0.001) with 57% of patients achieving values <7%; weight loss -6.95 kg(p<0.001) with 59% of patients showing reduction>5% of their body weight. Systolic and diastolic blood pressure decreased -9.85 mmHg and -5.92 mmHg, respectively(p<0.001). The mean UACR reduced 51% in the group with baseline macroalbuminuria (UACR)>300 mg/g. Mean eGFR (by CKD-EPI) remained stable. The needs of basal insulin decreased 20% (p<0.005). Only 7% of patients on insulin had mild hypoglycemic episodes. Semaglutide was stopped in 5.7% of patients for digestive intolerance. Conclusions In this real-world study, patients with T2D and CKD treated with subcutaneous semaglutide for 12 months significantly improved glycemic control and decreased weight. Albuminuria decreased by >50% in patients with macroalbuminuria. The administration of GLP-1RA in patients with T2D and CKD was safe and well tolerated.

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