Reshaping Kidney Care: Q&A with Stylianos Sarrigiannidis

GLP-1s continue to be one of the top stories in the pharma industry. While the drugs are incredibly popular for their weight loss assistance, researchers continue to explore new indications for these medications. Stylianos Sarrigiannidis, senior business analyst at Lifescience Dynamics, spoke with Pharmaceutical Executive about how GLP-1s are impacting kidney treatments and how the industry is continuing to research in this area.

Pharmaceutical Executive: How effective have GLP-1s been shown to be at protecting kidney function?
Stylianos Sarrigiannidis: Among the strongest kidney-related evidence for GLP-1s today comes from Novo Nordisk’s FLOW trial in patients who have both chronic kidney disease (CKD) and type 2 diabetes. In that study, semaglutide reduced the risk of major kidney outcomes by about 24% versus placebo. That’s meaningful, but it’s important to understand the scope: every patient in the trial had diabetes-related CKD. We don’t yet have data showing that GLP-1s protect kidney function in people who have CKD without type 2 diabetes, and the FDA label reflects that limitation.

The main takeaway is that GLP-1s appear to provide kidney protection in a specific, well-defined population, CKD driven by type 2 diabetes, but we don’t have evidence or regulatory support for broader use in kidney disease more generally.

PE: How are GLP-1s and SGLT2s changing the CKD treatment paradigm?
Sarrigiannidis: SGLT2s also started as type 2 diabetes treatments and have now become a foundational therapy in nephrology because they consistently show kidney-protective effects across broad CKD populations, including many without diabetes.

GLP-1s work quite differently to SGLT2s and are used in CKD in a narrower way. Their kidney benefit has only been demonstrated in patients who have both type 2 diabetes and CKD, and that’s exactly how the current FDA label is written. For now, they expand treatment options within that specific subgroup, and they also open the door for companies to engage nephrologists directly, rather than treating GLP-1s solely as diabetes or obesity drugs.

SGLT2s have already reshaped the standard of care, and GLP-1s are beginning to layer on additional cardiometabolic and renal benefits, but their role in kidney disease is still much earlier and more limited compared to SGLT2s.
 

PE: What’s driving the push for more collaboration between nephrology and endocrinology?
Sarrigiannidis: A big driver is the growing recognition that kidney disease and metabolic disease are tightly interconnected. A lot of type 2 diabetes patients have cardiometabolic and kidney related comorbidities, and some treatments that endocrinologists have traditionally used have shown or are now showing benefits in kidney outcomes as well. SGLT2 inhibitors have already demonstrated that overlap, and GLP-1s are reinforcing this in patients who have both diabetes and CKD.

Because these newer therapies reach across specialties, silos are breaking down. Endocrinologists are increasingly thinking about renal risk when managing diabetes. The more data we get showing cross-organ benefits, the more coordinated the care model needs to become. GLP-1s are viewed more and more as treatment options that improve overall patient health rather than being specific to obesity or type 2 diabetes which may increase their uptake in the future.

The push isn’t just about new drugs. There’s a broader shift happening toward treating the entire cardiometabolic–renal spectrum rather than viewing kidney disease in isolation.

PE: Where is kidney medicine headed next?
Sarrigiannidis: Kidney medicine is moving toward more precise, mechanism-based treatments rather than treating CKD as a single disease. Doctors are focusing on specific conditions like IgA nephropathy, targeting underlying biology with new therapies. At the same time, the field is increasingly integrating cardiometabolic approaches, promoting the use of treatment combinations. The trend is toward earlier intervention, and more personalized care. While SGLT2s, that originated as type 2 diabetes drugs, are now established as background treatment in kidney disease. That said SGLT2s are slowly being displaced by more targeted treatments as the CKD space gets segmented. As the kidney disease space rapidly evolves, it remains unclear if GLP-1s will be used to treat CKD outside type 2 diabetes or obesity.