Background: Real-world kidney and metabolic responses to semaglutide in type 2 diabetes (T2D) and chronic kidney disease (CKD) remain poorly characterised, particularly in Middle East and North Africa (MENA) region. Methods: We conducted a retrospective, single-centre, paired-cohort study at a secondary care hospital in UAE. Adults with T2D and predominantly mild CKD newly initiated on subcutaneous semaglutide were included. Single-arm design without comparator; findings describe biomarker trajectories and cannot establish causality. Primary outcomes were within-participant six-month changes in serum creatinine, estimated glomerular filtration rate (eGFR), and urinary albumin-to-creatinine ratio (uACR). Results: A total of 324 patients were analysed (mean age 55.3 ± 12.4 years; 66.0% female; BMI 36.1 ± 6.9 kg/m2; median HbA1c 8.3% [IQR 7.2-10.0]; eGFR 87.0 ± 25.8 mL/min/1.73 m2; KDIGO G1-G2 in 82.7%; A2 92.6%, A3 4.6%). At six months, BMI fell by 2.0 kg/m2 and HbA1c by a median 2.0%; 52.0% achieved ≥5% BMI reduction and 87.2% achieved ≥0.5% absolute HbA1c reduction. Serum creatinine decreased by 3.6 µmol/L and eGFR rose by 3.7 mL/min/1.73 m2; given concurrent weight loss, these changes likely reflect reduced creatinine generation rather than true filtration improvement. A ≥30% eGFR decline occurred in only 0.9%. Geometric mean uACR fell by 19.8%; among participants with baseline uACR ≥ 30 mg/mmol, 66.7% achieved ≥30% uACR reduction. KDIGO G-category improved in 17.3% and was stable in 76.8%; the A-category remained stable in 95.7%. Conclusions: In adults with T2D, mild CKD, and substantial obesity, semaglutide was associated with clinically meaningful improvements in weight, glycaemia, and albuminuria over six months, supporting it as part of a layered cardio-renal protective strategy in routine care.
