This project aims to investigate how Chronic Kidney Disease (CKD) develops and progresses in patients who also have Non-Alcoholic Fatty Liver Disease (NAFLD) and to evaluate whether oral semaglutide (a GLP-1 receptor agonist) can slow or prevent this progression.
NAFLD and CKD frequently coexist due to shared mechanisms such as insulin resistance, inflammation, oxidative stress, dyslipidemia, and metabolic syndrome. Because of these overlapping pathways, a single therapy targeting both organs may offer major benefits.
Semaglutide is known to reduce liver fat, improve inflammation and fibrosis, promote weight loss, and provide renal protection. This project will test whether adding oral semaglutide to standard care leads to better kidney and liver outcomes than standard care alone.
The study is designed as a randomised controlled trial conducted at ILBS, enrolling adults having NAFLD with CKD (with specific eGFR and albuminuria criteria). Participants will be followed for 2 years, with regular assessment of kidney function (eGFR, ACR), liver health (FibroScan, ALT/AST), metabolic parameters, and cardiovascular outcomes.
A parallel animal study in mice with diet-induced fatty liver disease will validate mechanistic findings through liver and kidney histology, gene expression, metabolic tests, and biochemical markers after semaglutide treatment.
Expected outcome: To demonstrate that semaglutide slows CKD progression and improves NAFLD, supporting its use as a therapeutic option for patients with coexisting both conditions.
serum creatinine-based eGFR greater than or equal to 50 and less than or equal to 75 mL/min/1.73 m² (CKD-EPI) and UACR greater than 300 and less than 5000 mg/g or
serum creatinine-based eGFR greater than or equal to 25 and less than 50 mL/min/1.73 m² (CKD-EPI) and UACR greater than 100 and less than 5000 mg/g 5.Treatment with maximum labelled or tolerated dose of a reninangiotensin-aldosterone system (RAAS) blocking agent including an angiotensin converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB), unless such treatment is contraindicated or not tolerated. Treatment dose must be stable for at least 4 weeks prior to the date of the laboratory assessments used for determination of the inclusion criteria for renal impairment and kept stable until screening.
Documented causes of chronic liver disease other than non-alcoholic fatty liver disease (NAFLD)
Positive HBsAg, positive anti-HIV, positive HCV RNA at screening (V2A) or any known presence of HCV RNA or HBsAg within 2 years of screening (V2A).
Presence or history of ascites, variceal bleeding, hepatic encephalopathy, spontaneous bacterial peritonitis or liver transplantation at randomisation.
Known or suspected excessive consumption of alcohol (greater than 20 g/day for women or greater than 30 g/day for men) or alcohol dependence (assessed by the Alcohol Use Disorders Identification Test (AUDIT questionnaire)).
Parallel
Semaglutide Oral Tablet
DrugGLP1-R agonists GLP1-R agonists (GLP1-RAs) are novel potent antidiabetic agents with proven efficacy in reducing major adverse cardiovascular events. Besides their glucose-lowering action, their beneficial hepatic effects may be related to the influence on the AMPK/mTOR pathway. Semaglutide was associated with significant decreases in body weight, alanine aminotransferase, liver steatosis, and stiffness.GLP1-RAs may also improve histologic features on NAFLD, such as liver fat deposition, steatohepatitis, and fibrosis. GLP1-RAs have shown benefits in preventing the development or halting the progression of CKD. It also promotes antioxidative and anti-inflammatory actions may be among the determining factors in this renoprotective effect, together with weight loss, blood pressure, and glucose-lowering.
Placebo
Other interventionPlacebo will be given in the same manner.
Standard medical treatment
Other interventionStandard medical treatment- 1. Lifestyle first - weight loss , caloric restriction, increased aerobic + resistance exercise, treat obesity and metabolic syndrome. 2. Optimize blood-pressure control and use RAAS blockade when indicated (ACE inhibitor or ARB) to reduce albuminuria and slow CKD progression . 3. Treat dysglycaemia and favour drug classes with kidney + liver benefit when appropriate * SGLT2 inhibitors (dapagliflozin, empagliflozin, canagliflozin) - recommended for people with T2D + CKD * GLP-1 receptor agonists (e.g., semaglutide) 4. Lipid management / statins - treat according to CV risk 5. Consider established liver-directed agents when appropriate 6. Pioglitazone (thiazolidinedione) and vitamin-E 7. Standard CKD supportive care - salt and fluid management, correction of metabolic acidosis, anaemia and mineral bone abnormalities as per CKD stage; immunize and address CV risk factors aggressively 8. Avoid hepatotoxic drugs / review medications
Time to first occurrence of a composite primary outcome event defined as persistent eGFR decline of greater than or equal to 50 percentage from trial start, reaching ESRD, death from kidney disease or death from cardiovascular disease.
Annual rate of change in eGFR (chronic kidney disease - epidemiology collaboration (CKD-EPI))
ime to first occurrence of a composite cardiovascular major adverse cardiovascular event (MACE) endpoint consisting of: Non-fatal myocardial infarction, non-fatal stroke, and cardiovascular (CV) death
Time to occurrence of all-cause death
Change in eGFR and proteinuria.
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