We are doing this study to learn more about how semaglutide may help fight chronic kidney disease in people with type 2 diabetes. We are doing this by looking into how semaglutide works in the kidneys. Participants will either get semaglutide or placebo (a 'dummy' medicine) - which treatment participants get is decided by chance. Semaglutide is a medicine doctors can prescribe in some countries for the treatment of type 2 diabetes. Participants will get the study medicine in a pen. Participants will use the pen to inject the medicine into the skin once a week. The study will last for about 1 year. Participants will have 11 visits to the clinic, and 2 phone visits. Some of the visits could be in different locations. Study staff will take blood samples at most of these visits. At 9 visits, participants will be asked to bring a sample of their first morning urine. At 4 of the visits participants will have to bring urine that they have collected over the last 24 hours. The study includes magnetic resonance imaging (MRI) scans of participants' kidneys which is a test that shows a detailed picture of organs and other parts inside the body. The scan will last for 30 minutes, and is free of radiation.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
106
Semaglutide given subcutaneously (sc, under the skin) once weekly. Dose gradually increased over 8 weeks from 0.25 to 1.0 mg. The study will last for about 1 year.
Placebo (Semaglutide) given subcutaneously (sc, under the skin) once weekly. Dose gradually increased over 8 weeks from 0.25 to 1.0 mg. The study will last for about 1 year.
University of Arizona-CaTs
Tucson, Arizona, United States
Academic Medical Research Institute
Los Angeles, California, United States
Roderick A. Comunale II MD Inc.
National City, California, United States
N America Res Inst - San Dimas
San Dimas, California, United States
UC Anschutz Medical Campus
Aurora, Colorado, United States
Change in Kidney Oxygenation (Cortex), Blood Oxygenation-level Dependent Magnetic Resonance Imaging (BOLD MRI) (R2*)
Change in kidney oxygenation in cortex assessed by BOLD (blood oxygenation level dependent) MRI from baseline (week 0) to end of treatment (week 52) is presented. R2\* is a measure used in BOLD MRI to indicate the level of tissue oxygenation. A higher R2\* value means lower tissue oxygenation while a lower R2\* value means higher tissue oxygenation.
Time frame: Baseline (week 0), End of treatment (week 52)
Change in Kidney Oxygenation (Medulla), BOLD MRI (R2*)
Change in kidney oxygenation in medulla assessed by BOLD (blood oxygenation level dependent) MRI from baseline (week 0) to end of treatment (week 52) is presented. R2\* is a measure used in BOLD MRI to indicate the level of tissue oxygenation. A higher R2\* value means lower tissue oxygenation while a lower R2\* value means higher tissue oxygenation.
Time frame: Baseline (week 0), End of treatment (week 52)
Change in Global Kidney Perfusion (MRI)
Change in global kidney perfusion assessed by phase contrast MRI from baseline (week 0) to end of treatment (week 52) is presented.
Time frame: Baseline (week 0), End of treatment (week 52)
Change in Kidney Inflammation (Cortex), Longitudinal Relaxation Time (T1) Mapping (MRI)
Change in kidney inflammation in cortex assessed by T1 mapping MRI from baseline (week 0) to end of treatment (week 52) is presented.
Time frame: Baseline (week 0), End of treatment (week 52)
Change in Kidney Inflammation (Medulla), T1 Mapping (MRI)
Change in kidney inflammation in medulla assessed by T1 mapping MRI from baseline (week 0) to end of treatment (week 52) is presented.
Time frame: Baseline (week 0), End of treatment (week 52)
Change in Gene Expression Assessed by Single Nucleus Ribonucleic Acid (RNA) Sequencing (Kidney Biopsy)
Changes in gene expression were assessed by single nucleus RNA sequencing (kidney biopsies) from baseline (week 0) to end of treatment (week 52). Cell type annotation was performed prior to the analysis. The analysis reports the log2 fold change in form of differential gene expression per cell type from baseline, comparing treatment arms. Genes are considered significant if fold change \> 0.5 or \< 0.5 and false discovery rate (FDR) \<0.1; these criteria help identify biologically significant genes that are reliably differentially expressed in patients with conditions such as Type 2 diabetes and chronic kidney disease. The differential expression was estimated using a linear mixed model that included participant as a random effect. The cell types presented are those that contain these differentially expressed genes demonstrating the treatment response. This threshold is based on findings published in cross-sectional observational studies related to disease impact and gene activity.
Time frame: Baseline (week 0), End of treatment (week 52)
Change in Glomerular Basement Membrane Width (Kidney Biopsy)
Change in glomerular basement membrane width assessed in kidney biopsy from baseline (week 0) to end of treatment (week 52) is presented.
Time frame: Baseline (week 0), End of treatment (week 52)
Change in Apparent Diffusion Coefficient (ADC) (Cortex) (MRI)
Change in apparent diffusion coefficient in cortex assessed by MRI from baseline (week 0) to end of treatment (week 52) is presented.
Time frame: Baseline (week 0), End of treatment (week 52)
Change in Apparent Diffusion Coefficient (ADC) (Medulla) (MRI)
Change in apparent diffusion coefficient in medulla assessed by MRI from baseline (week 0) to end of treatment (week 52) is presented.
Time frame: Baseline (week 0), End of treatment (week 52)
Change in Mean Renal Artery Resistive Index (RARI) (MRI)
Change in renal arterial resistive index assessed by MRI from baseline (week 0) to end of treatment (week 52) is presented. RARI measures the preservation of blood flow in renal arteries throughout the cardiac cycle and is therefore a measure for resistance of blood flow within the renal arteries. It serves as an indicator of kidney vascular health and potential arterial stiffness or obstruction. It is prognostic for primary cardiovascular and renal events in type 2 diabetes, where a lower RARI predicts a lower rate of events. RARI is calculated by relating the difference between blood flow at maximum velocity during the cardiac contraction phase (peak systolic velocity, PSV) and the speed at the end of the relaxation phase, at the point of minimal velocity (end diastolic velocity, EDV) with PSV, i.e., RARI = (PSV-EDV)/PSV.
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Advent Health-Res Inst
Orlando, Florida, United States
Atlanta Diabetes Associates
Atlanta, Georgia, United States
Emory University Hsptl - Atlanta
Atlanta, Georgia, United States
Endeavor Health Glenbook Hosp
Evanston, Illinois, United States
North Suburban Nephrology LLC
Gurnee, Illinois, United States
...and 39 more locations
Time frame: Baseline (week 0), End of treatment (week 52)
Change in Mean Arterial Flow (MRI)
Change in mean arterial flow assessed by MRI from baseline (week 0) to end of treatment (week 52) is presented.
Time frame: Baseline (week 0), End of treatment (week 52)
Change in Natriuresis (Urinary Sodium Excretion) (Urinalysis)
Change in natriuresis (urinary sodium excretion) (urinalysis) from baseline (week 0) to end of treatment (week 52) is presented.
Time frame: Baseline (week 0), End of treatment (week 52)
Change in Albumin Excretion Rate (Urinalysis)
Change in albumin excretion rate (urinalysis) from baseline (week 0) to end of treatment (week 52) is presented.
Time frame: Baseline (week 0), End of treatment (week 52)
Change in Kidney Function (Creatinine Clearance) (Urinalysis)
Change in kidney function (creatinine clearance) (urinalysis) from baseline (week 0) to end of treatment (week 52) is presented.
Time frame: Baseline (week 0), End of treatment (week 52)