Ozempic kidney disease protection is now part of the drug’s label. In the FLOW trial of adults with type 2 diabetes and chronic kidney disease (CKD), semaglutide 1 mg weekly cut the risk of major kidney events or death from kidney or heart causes by 24%.[1] The FDA added this use to Ozempic’s label in January 2025.[2][3] The main kidney risk is different: dehydration from nausea, vomiting or diarrhea can cause acute kidney injury.[2]
For background on the drug, see our semaglutide profile.
What Ozempic is approved for in kidney disease
The Ozempic label lists three uses in adults with type 2 diabetes:[2]
- Improving blood sugar control, with diet and exercise.
- Reducing the risk of heart attack, stroke and cardiovascular death in people with heart disease.
- Reducing the risk of sustained eGFR decline, end-stage kidney disease and cardiovascular death in people with chronic kidney disease.
eGFR (estimated glomerular filtration rate) is the standard blood-test estimate of how well the kidneys filter. A sustained drop means kidney function is getting worse. End-stage kidney disease means needing dialysis or a transplant.
The kidney indication was announced on January 28, 2025, making Ozempic the first GLP-1 drug with this use.[3] It applies only to people who have type 2 diabetes. Semaglutide is not approved for kidney disease alone.
The FLOW trial
FLOW tested semaglutide 1 mg weekly against placebo in 3,533 adults with type 2 diabetes and CKD.[1]
- Who was included: people with an eGFR of 50 to 75 and high protein (albumin) in the urine, or an eGFR of 25 to under 50 with raised albumin.[1]
- How long: median follow-up of 3.4 years. The trial stopped early because results at a planned interim check were clear.[1]
| Outcome | Semaglutide vs placebo |
|---|---|
| Kidney failure, 50%+ eGFR drop, or kidney or heart death | 24% lower risk (331 vs 410 events)[1] |
| Kidney-only parts of that outcome | 21% lower risk[1] |
| Death from cardiovascular causes | 29% lower risk[1] |
| Major cardiovascular events | 18% lower risk[1] |
| Death from any cause | 20% lower risk[1] |
| Yearly eGFR decline | Slower by 1.16 points per year[1] |
Serious adverse events were slightly less common with semaglutide (49.6%) than with placebo (53.8%).[1]
Ozempic with SGLT2 inhibitors
SGLT2 inhibitors, such as empagliflozin (Jardiance) and dapagliflozin (Farxiga), are a standard kidney-protecting treatment. In FLOW, 550 people (about 16%) were already taking one.[4]
- Not on an SGLT2 inhibitor: semaglutide lowered the main outcome by 27%.[4]
- On an SGLT2 inhibitor: event rates were similar on semaglutide and placebo (41 vs 38 events), but this group was small and the difference between subgroups was not statistically significant.[4]
The trial was not built to answer whether adding semaglutide to an SGLT2 inhibitor gives extra protection.
Kidney results in people without diabetes
SELECT studied 17,604 adults with heart disease and overweight or obesity, but no diabetes, on semaglutide 2.4 mg (the Wegovy dose).[5]
- A kidney composite outcome occurred in 1.8% on semaglutide versus 2.2% on placebo, a 22% lower risk.[5]
- eGFR declined more slowly, especially in people who started with an eGFR under 60.[5]
A 2026 pooled analysis of SELECT, FLOW and the SOUL trial of oral semaglutide, covering 30,787 people, found a 16% lower risk of major kidney outcomes.[6] These findings support a broader kidney benefit, but there is no FDA-approved kidney use outside type 2 diabetes.
Acute kidney injury: the dehydration warning
The kidney risk to know about is acute kidney injury (AKI), a sudden drop in kidney function.
The Ozempic label reports postmarketing cases of AKI, some needing dialysis. Most happened in people who became dehydrated from nausea, vomiting or diarrhea.[2] The label tells clinicians to check kidney function in people with these side effects, especially when starting or increasing the dose.[2] Wegovy carries the same warning.[7]
Steps that lower this risk:
- Drink fluids steadily, especially in the first weeks and after each dose increase.
- Tell your prescriber about vomiting or diarrhea that lasts more than a day or stops you keeping fluids down.
- Watch for warning signs: much less urine, dark urine, dizziness when standing, or unusual swelling.
- Review other medicines with your clinician, since some can add to kidney strain when you are dehydrated.
For ways to manage nausea, see our GLP-1 nausea guide.
Questions to ask your care team
If you have type 2 diabetes and CKD, these questions can help you decide with your clinician whether Ozempic fits your plan:
- What are my latest eGFR and urine albumin results? FLOW enrolled people based on both numbers, so they show how closely your situation matches the trial.[1]
- How often will my kidney function be checked after I start or increase the dose? The label advises monitoring in people with side effects that could cause dehydration.[2]
- What should I do if I cannot keep fluids down? Agree on a plan in advance, such as when to call and whether to skip a dose.
- How does this fit with my other kidney treatments, such as an SGLT2 inhibitor or blood pressure medicine?[4]
Dosing with kidney disease
The Ozempic label recommends no dose adjustment for kidney impairment, including kidney failure.[2] FLOW used the 1 mg weekly dose.[1] Ozempic starts at 0.25 mg and increases in steps; your prescriber sets the dose and pace. Our semaglutide dosage chart shows each step.
People on dialysis were not included in FLOW, so evidence in that group is limited.[1]
How Ozempic compares with other options
Ozempic is the only GLP-1 drug with an FDA-approved kidney indication.[3] Tirzepatide (Mounjaro) does not have one; see semaglutide vs tirzepatide for the full comparison of approved uses. Kidney care in type 2 diabetes usually combines several treatments, including blood pressure control, so any change should be discussed with your care team.
Other long-term safety questions
Semaglutide also carries a boxed warning about thyroid tumors seen in rodents.[2] Our guide to semaglutide and cancer risk explains the human data.
