A large-scale study of about 10,000 patients has found that oral semaglutide, a medication already approved for type 2 diabetes, significantly slows the loss of kidney filtering capacity over roughly 4 years PMID:41380027. While the pill did not significantly reduce the total count of severe kidney failure cases in this specific group, its ability to stabilize kidney function offers a critical protective strategy for patients managing both diabetes and heart disease. ### Key Findings In the SOUL trial, which followed about 10,000 adults for approximately 4 years, researchers compared daily oral semaglutide (14 mg) to a placebo pill: - **Slower Function Loss:** Patients taking the pill experienced significantly less decline in their kidney "filtering power" (measured as eGFR) compared to those on the placebo. On average, the pill preserved about 0.40 mL/min of filtering capacity every year. - **Major Kidney Events:** The study tracked a composite of severe outcomes, including a 50% drop in kidney function or kidney failure. Without treatment (the baseline), about 9 out of 100 people experienced one of these events. With the semaglutide pill, about 8 out of 100 people experienced an event. This specific difference was not considered statistically significant for this trial group. - **Safety Profile:** Serious side effects were similar between the two groups, though digestive issues like nausea were more frequent in those taking the medication. ### The Medical Context Chronic kidney disease is one of the most frequent complications of type 2 diabetes, affecting between 20 to 50 out of every 100 patients PMID:39376661. This condition is closely linked to heart disease, as kidney decline significantly increases the risk of heart-related death PMID:35023547. Previously, a large trial called FLOW showed that the injectable version of semaglutide reduced major kidney events by roughly 24% in patients with advanced disease PMID:38785209. This new data from the SOUL trial is vital because it demonstrates that the oral pill version provides a similar protective benefit for kidney function, even in patients who start with relatively healthy kidneys PMID:41380027. Furthermore, the SOUL trial established that this same oral treatment reduces the risk of major heart events; specifically, the risk dropped from about 14 out of 100 people in the placebo group to 12 out of 100 people in the treatment group PMID:40162642. ### Clinical Takeaway For patients with type 2 diabetes and a high risk of heart disease, these findings suggest that the oral form of semaglutide is a powerful tool for long-term organ protection. - **Access:** Oral semaglutide is currently available under the brand name Rybelsus and is already FDA-approved for blood sugar management. - **Patient Choice:** This medication is a robust alternative for individuals who prefer a daily pill over a weekly injection but still want to protect their heart and kidneys. - **Expectations:** While the pill helps stabilize kidney function, patients should be prepared for potential stomach-related side effects, which are common when starting this class of medication. ### Caveats Most participants in this study had relatively healthy kidneys at the start (preserved eGFR). This likely explains why the drug showed a stabilization of function rather than a dramatic reduction in actual kidney failure cases, which occur more frequently in patients with more advanced disease.