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Means lower Emerging observational studies and small interventional trials suggest that GLP-1 RAs may be used in patients with advanced CKD with preserved glucose-lowering efficacy and a relatively low intrinsic risk of hypoglycemia compared with insulin and sulfonylureas ( Semaglutide has recently received expanded regulatory approval for use in patients with T2DM and CKD, reflecting growing confidence in its renal safety profile and potential kidney-protective benefits ( In Saudi Arabia, T2DM prevalence is among the highest worldwide and is accompanied by high rates of obesity, cardiovascular disease, and CKD ( Therefore, this multicenter retrospective study aimed to evaluate the real-world safety and effectiveness of semaglutide in patients with ESRD receiving care at Saudi tertiary healthcare centers, with a focus on glycemic outcomes, body weight changes, cardiovascular events, renal safety, and treatment tolerability