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The American Diabetes Association (ADA) 2026 guidelines recommend semaglutide in patients with advanced CKD without specifying eGFR cutoffs and note that its glucose-lowering effect is preserved at low eGFR levels, in contrast to SGLT2 inhibitors, whose glycemic efficacy diminishes with declining kidney function ( In our cohort, semaglutide use was associated with a modest reduction in HbA1c (0.31 2.57%, p = 0.630) and a numerically large but statistically non-significant reduction in body weight (12.63 24.03 kg, p = 0.074)

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