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The recently initiated large-sized FLOW trial investigating the effects of semaglutide on hard renal outcomes in patients with DKD will provide clarity whether GLP-1 receptor agonists may reduce the burden of DKD in addition to their other beneficial metabolic and cardiovascular effects.

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In clinical practice, drug selection should therefore prioritize factors such as tolerability, safety profile, adherence, cost, and patient preference rather than expecting major differences in cardiovascular efficacy.