Type 2 · call recap
What the kidney trial changed about the questions we ask
16 April 202514 attendedHeld by Mira
Sunil came over from the reading group for this one and we ran it jointly. The subject was FLOW — Perkovic V, et al. New England Journal of Medicine 2024;391(2):109 to 121 — and what it does and does not mean for the fourteen people in the room, seven of whom have some degree of kidney involvement and most of whom had heard a version of the result that was several steps beyond the paper.
What the paper is
A trial of semaglutide in people with type 2 diabetes and chronic kidney disease, with a composite kidney outcome. It was stopped early for efficacy. Sunil took the room through the actual population — which matters enormously here, because the trial recruited people with a specific level of kidney involvement and albuminuria, and half the room does not resemble them.
The claim that had reached most people was some version of it protects your kidneys. What the paper supports is narrower and still substantial, in a defined population, over a defined period, on a composite endpoint that includes several different events.
What the room concluded
That the useful output was not a fact, it was a question. Several people had been treating their eGFR as a thing to worry about privately. What they took away was a specific thing to ask: given my numbers and my history, does this trial population look anything like me, and does that change what you would monitor.
Ravi, who reads more than most, made the honest objection: that a paper does not change what his practice will do, and that his nurse had not mentioned it. Which is true and worth saying. Sunil's answer was that reading it changes what he can ask, not what he can prescribe.
Where we left it
With one correction I want on the record. Somebody said, reasonably, that a composite endpoint is a way of making a result look better. That is sometimes true and it is not automatically true, and we spent five minutes on why. Nobody was made to feel stupid, which in a room with two clinicians in it takes some doing.