Semaglutide outperforms dulaglutide for reducing proteinuria in diabetic kidney disease | Research

The takeaway

In 1,015 diabetic patients over 12 months, semaglutide and dulaglutide had comparable effects on eGFR preservation, but semaglutide was significantly more effective at reducing proteinuria (UACR), particularly in higher BMI, higher HbA1c, and older patient subgroups.

Semaglutide better for proteinuria
In direct comparison with dulaglutide, semaglutide showed significantly greater proteinuria reduction in diabetic patients, especially those with higher BMI and HbA1c

What the researchers found

eGFR: similar decline in both groups (NS). UACR: dulaglutide significantly higher increases vs semaglutide (p significant). Semaglutide superior for UACR in: higher BMI, higher HbA1c, older patients. 747 semaglutide vs 268 dulaglutide, 12 months.

Why it matters

Proteinuria is a major driver of kidney disease progression. Demonstrating that semaglutide reduces it more than dulaglutide helps clinicians choose the best GLP-1 drug for diabetic kidney disease.

How the study worked

Retrospective cohort at Wanfang Hospital, Taipei (Jan 2022-Sep 2024). 1,015 patients. eGFR and UACR at 12 months. Subgroup analyses.

What this study cannot tell us

Retrospective. Single center in Taiwan. Groups not perfectly balanced at baseline. Specific UACR values not detailed in abstract. 12-month follow-up may not capture long-term differences.

How to read the evidence

Retrospective single-center head-to-head comparison. Good real-world evidence for drug selection.

When this study was published

Published in 2025; data 2022-2024.

The bigger picture

Not all GLP-1 drugs are equal for kidney protection. This head-to-head comparison in a real-world setting supports semaglutide as the preferred choice when proteinuria reduction is important.

Questions still open

What mechanism makes semaglutide superior for proteinuria?
Does the proteinuria advantage translate to better long-term kidney outcomes?
Would tirzepatide show even greater renal benefits?

Common questions

Which GLP-1 drug is better for kidneys?

This study found both semaglutide and dulaglutide preserved kidney filtration rate equally, but semaglutide was significantly better at reducing proteinuria—protein leaking into urine, which indicates kidney damage. This advantage was greatest in heavier, less controlled, and older patients.

Does proteinuria reduction matter?

Yes—proteinuria is both a marker of kidney damage and a driver of further decline. Reducing it slows the progression to kidney failure. By showing semaglutide is better at this than dulaglutide, this study supports choosing semaglutide when kidney health is a concern.

Read the original research

Comparative Effects of Dulaglutide and Semaglutide on Renal Function Decline and Proteinuria Reduction in Diabetic Patients: A Retrospective Cohort Study.

Journal of clinical medicine, 14(12)

View on PubMed ↗Publisher’s paper ↗

Citation

Sue, Yuh-Mou; Lu, De-En; Chang, Te-I; Chen, Chun-You; Chen, Cheng-Hsien; Hsu, Shih-Chang; Chu, Yen-Ling; Huang, Nai-Jen; Chen, Tso-Hsiao; Lin, Feng-Yen; Shih, Chun-Ming; Huang, Po-Hsun; Hsieh, Hui-Ling; Liu, Chung-Te. (2025). Comparative Effects of Dulaglutide and Semaglutide on Renal Function Decline and Proteinuria Reduction in Diabetic Patients: A Retrospective Cohort Study.. Journal of clinical medicine, 14(12). https://doi.org/10.3390/jcm14124287