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Once considered to act primarily through reductions in albuminuria, GLP-1RAs now have dedicated hard-endpoint evidence: in the FLOW trial, semaglutide reduced the primary composite kidney outcome ( 50% eGFR decline, kidney failure, or kidney or cardiovascular death) by 24% (hazard ratio 0.76, 95% CI 0.660.88) in type 2 diabetes and CKD and slowed eGFR decline [48, 49]

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