The short answer: Yes, but mostly in one way. The Ozempic label warns of acute kidney injury, and most reported cases followed vomiting or diarrhea that led to dehydration. In adults with type 2 diabetes and chronic kidney disease, the evidence points the other way. In the FLOW trial, major kidney events were 24% less likely with semaglutide than with placebo, and the FDA added a kidney indication in January 2025.

What does the Ozempic label warn about the kidneys?

The warning sits in section 5.6 of the current Ozempic prescribing information. Its title is "Acute Kidney Injury Due to Volume Depletion." Volume depletion means the body has lost too much fluid.

The label says there have been postmarketing reports of acute kidney injury in people treated with semaglutide. Some of those cases needed hemodialysis. Most of the reported events happened in people who had nausea, vomiting, or diarrhea that led to dehydration.

These are postmarketing reports. They come from use after approval, and the label gives no rate for them. The label does not say how often kidney injury happens. It also does not say that semaglutide damages kidney tissue directly.

The label asks prescribers to monitor kidney function in people who report reactions that could cause fluid loss. It names two periods of special concern: when the medicine is started and when the dose goes up.

Who is most at risk of kidney injury on Ozempic?

The label ties the risk to fluid loss. So the people at risk are those with stomach side effects that are strong enough, or last long enough, to cause dehydration.

Stomach side effects are common. In the pooled placebo-controlled trials in the label, gastrointestinal reactions occurred in 32.7% of people on Ozempic 0.5 mg and 36.4% on 1 mg. The rate with placebo was 15.3%. The label says most reports of nausea, vomiting, or diarrhea came during dose escalation.

Most of those reactions do not lead to kidney injury. The concern starts when a person cannot keep fluids down or has diarrhea that does not stop. Our guide to managing Ozempic nausea covers the common, milder end of this problem.

Other things can strain the kidneys at the same time. MedlinePlus lists causes of acute kidney failure that include dehydration, very low blood pressure, and some medicines. Its examples are NSAID pain relievers, certain antibiotics, and certain blood pressure medicines. Ask your prescriber how your other medicines fit with a period of vomiting or diarrhea.

What did the FLOW kidney trial find?

FLOW was a randomized, double-blind trial published in the New England Journal of Medicine in 2024. It enrolled 3,533 adults with type 2 diabetes and chronic kidney disease. Of those, 1,767 received semaglutide 1 mg by injection once a week and 1,766 received placebo. Median follow-up was 3.4 years. The trial stopped early after a planned interim analysis.

The primary outcome was a composite called major kidney disease events. It counted four things:

  • Kidney failure (dialysis, transplant, or an eGFR below 15 ml per minute per 1.73 m2).
  • A drop in eGFR of at least 50% from baseline.
  • Death from kidney-related causes.
  • Death from cardiovascular causes.

A first event occurred in 331 people in the semaglutide group and 410 in the placebo group. The label reports these as 18.7% and 23.2% of each group. The hazard ratio was 0.76 (95% CI, 0.66 to 0.88), a 24% lower relative risk.

Other results pointed the same way:

  • Kidney function fell more slowly with semaglutide. The yearly eGFR decline was smaller by 1.16 ml per minute per 1.73 m2 than with placebo.
  • The risk of death from any cause was 20% lower than with placebo (hazard ratio 0.80; 95% CI, 0.67 to 0.95).
  • Serious adverse events were reported in 49.6% of the semaglutide group and 53.8% of the placebo group.

The trial has limits, and the label states them. Not every part of the composite was clearly lower on its own. For chronic kidney replacement therapy, the hazard ratio was 0.84, with a confidence interval of 0.63 to 1.12. That range includes no difference. The benefit was also not evident in people who took an SGLT2 inhibitor at baseline, but that group had few events. Novo Nordisk, the maker of Ozempic, funded the trial.

FLOW also reported fewer heart events. Our article on Ozempic and cardiovascular benefits covers that evidence.

Is Ozempic approved for kidney disease?

Yes, for one group. The label states that Ozempic is indicated "to reduce the risk of sustained eGFR decline, end-stage kidney disease, and cardiovascular death in adults with type 2 diabetes mellitus and chronic kidney disease."

The FDA approval letter for this indication belongs to supplement 25. The FDA drug database dates that supplement January 28, 2025.

The indication is narrow. It covers adults who have both type 2 diabetes and chronic kidney disease. FLOW excluded people with inherited kidney diseases such as polycystic kidney disease, and people with autoimmune kidney diseases such as glomerulonephritis. The label also says the way semaglutide lowers kidney risk "has not been established."

A pooled analysis published in 2026 looked wider. It combined 30,787 participants from three semaglutide trials: FLOW, SELECT, and SOUL. SELECT and SOUL enrolled people with cardiovascular disease, and the trials used different doses and forms of semaglutide. A kidney composite occurred as a first event in 973 people on semaglutide and 1,134 on placebo (hazard ratio 0.84; 95% CI, 0.77 to 0.91). This supports the FLOW result. It does not change the approved indication.

Can you take Ozempic if your kidney function is already low?

The label does not make reduced kidney function a reason to avoid Ozempic. Section 8.6 says no dose adjustment is recommended for people with renal impairment. In studies that included people with kidney failure, the amount of semaglutide in the blood did not change in a clinically relevant way.

FLOW itself enrolled people with reduced function. Mean eGFR at the start was 47 ml per minute per 1.73 m2, and 11% of participants were below 30. For scale, NIDDK says a GFR of 60 or more is in the normal range, and a GFR of 15 or less is called kidney failure.

Two points sit together here. The dehydration warning applies to everyone on Ozempic, including people with kidney disease. And the trial benefit was measured over years, in people who stayed on treatment under medical care.

How can you protect your kidneys while taking Ozempic?

The Medication Guide in the label gives two instructions. Drink fluids to lower the chance of dehydration. Tell your healthcare provider right away if you have nausea, vomiting, or diarrhea that does not go away.

Know the general warning signs too. MedlinePlus lists symptoms of acute kidney failure, including:

  • Passing little or no urine.
  • Swelling in the legs, ankles, or feet.
  • Fatigue.
  • Nausea or vomiting that lasts for days.
  • Shortness of breath.

Routine testing matters more than symptoms for long-term kidney health. NIDDK says about 1 in 3 adults with diabetes has kidney disease, and most have no symptoms. It advises a kidney check every year for people with type 2 diabetes. The check uses a blood test for GFR and a urine test for albumin.

NIDDK also says the best way to slow diabetic kidney disease is to reach blood glucose and blood pressure goals. Sibling site hypertension.md covers blood pressure in more detail. For other risks seen with long-term use, see our review of Ozempic long-term side effects.

The bottom line

Ozempic can lead to kidney problems, and the label names the route: fluid loss from vomiting or diarrhea. The label gives no rate for these cases. The risk is highest when the medicine is started and when the dose goes up.

The trial evidence shows a kidney benefit in a specific group. In 3,533 adults with type 2 diabetes and chronic kidney disease, major kidney events were 24% less likely with semaglutide 1 mg than with placebo over a median of 3.4 years. Both facts are in the same label. Report stomach symptoms that do not stop, keep your yearly kidney tests, and ask your prescriber which side applies most to you.

Last updated: October 2026. This article is for informational purposes only and does not constitute medical advice. Talk with your prescriber or a kidney specialist about your own kidney function before you start, stop, or change any medication.