KevinCompounds said:Steady state is the thing most people miss.
Thank you — that is the clearest version of this I have read, and I have read a lot of them. Printing the relevant bit and taking it with me.
Clinical perspective, offered as context rather than as advice.
Kidney function labs on renal function — good news for anyone concerned about renal effects:
| Marker | Baseline | Month 6 | Ref Range |
|---|---|---|---|
| eGFR | 83 | 90 | >60 |
| Creatinine | 1.3 | 1.0 | 0.7-1.3 |
| BUN | 19 | 17 | 7-20 |
| UACR | 68 | 21 | <30 |
The FLOW trial demonstrated renal protective effects of semaglutide. My nephrologist is encouraged by the UACR improvement especially.
DeniseRN_TPA said:Albumin binding above 99% is the whole reason weekly dosing works, and it is also why the trough matters more than the peak.
I will push back on the "any working dose is fine" framing. The maintenance evidence sits overwhelmingly at the top studied dose, and the extension data shows regain tracking dose reduction rather than tracking stopping. Holding low is reasonable; pretending it is evidentially equivalent is not.
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Shop Reference StandardsDr.RenalNash said:FLOW is the relevant trial and it reported a meaningful reduction in kidney-disease progression and related death in people with type 2 diabetes and…
The FLOW trial results on renal function and renal outcomes: semaglutide 1.0mg reduced the composite kidney outcome by 24% (HR 0.76, p=0.0003) in CKD patients with T2DM[1].
The trial was stopped early for efficacy — always a strong signal. GFR decline was 1.16 mL/min/1.73m²/year slower with semaglutide. This positions GLP-1 agonists alongside SGLT2 inhibitors as pillars of cardiorenal protection in T2DM.
Moderator note: good thread. Keeping it here rather than moving it, because the question is general enough to be useful. Tagging this one for the weekly digest.