Kidney function on semaglutide — my results so far

PharmD_Rodriguez said:

The dose-response is real but shallow at the top.

This is where I part company with the consensus forming above. The trial means are being read too generously in this thread. STEP populations were selected, supported, and titrated by protocol, and the real-world curves are consistently a few points worse. That difference is not noise, it is what happens when you remove the study infrastructure.

One concrete data point for the thread. For anyone assembling their own picture: Tmax is one to three days, terminal half-life about 165 to 170 hours, steady state at four to five weeks, and subcutaneous bioavailability near 89%. Those four numbers explain most of the questions people ask about timing.

Worth separating that from renal function, which this thread keeps folding into the same question. They behave differently and the advice does not transfer.

COA_Karl said:

The trial means are being read too generously in this thread.

Coming at COA_Karl’s question from a different direction. 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 chronic kidney disease. The mechanism looks to be a mixture of reduced albuminuria, better glycaemia and blood pressure, and a probable direct anti-inflammatory effect on the glomerulus. Separately, eGFR is genuinely noisy during rapid weight loss — a small early dip is common and usually haemodynamic rather than damage.

A narrower follow-up, since the general answer is now clear:

How to read eGFR during rapid weight loss, given that creatinine depends on muscle mass and muscle mass is changing?

Reporting back.

Six weeks on from posting: I stopped reading the weekly number and started reading a four-week average, and the "stall" I opened this thread about was a 1.8kg loss I could not see.