During this clinical trial, you will receive one of four possible treatments. The treatment assigned to you will be determined randomly, similar to flipping a coin.

The four possible treatment options are: cagrilintide combined with semaglutide, semaglutide alone, cagrilintide alone, or placebo (an inactive substance that looks like the medication but contains no active ingredients).

All medications in this trial are given as injections under the skin (subcutaneous injections), except for some additional medications that are taken by mouth.

You will receive your assigned treatment once weekly throughout the study period.

The treatment will continue until the end of the study, which is estimated to last until November 2025.

If you are assigned to receive cagrilintide combined with semaglutide, you will receive a dose of 2.4 mg of cagrilintide and 2.4 mg of semaglutide in a single injection once weekly.

If you are assigned to receive semaglutide alone, you will receive a dose of 2.4 mg once weekly.

If you are assigned to receive cagrilintide alone, you will receive a dose of 2.4 mg once weekly.

If you are assigned to receive placebo, you will receive an injection that contains no active medication once weekly.

Some participants may also receive additional medications by mouth, including finerenone, dapagliflozin, or enalapril, depending on your specific medical needs.

Throughout the trial, you must continue taking your current medication for blood pressure control. This medication should be either an ACE inhibitor (a type of blood pressure medication that helps protect the kidneys) or an ARB (angiotensin II receptor blocker, another type of blood pressure medication).

You should be taking the maximum dose recommended on the medication label or the highest dose you can tolerate.

The dose of this blood pressure medication must remain stable and unchanged during the trial.

You will attend regular visits at the study site throughout the trial period.

During these visits, measurements will be taken to assess how the treatment is affecting your condition.

Your kidney function will be monitored through blood tests that measure eGFR (estimated glomerular filtration rate, which indicates how well your kidneys are filtering waste from your blood). This will be measured using both creatinine and cystatin C levels in your blood.

Your urine albumin-to-creatinine ratio (UACR) will be checked. This test measures the amount of protein in your urine, which is an indicator of kidney damage.

Your body weight will be measured at each visit to track changes during the treatment.

Your waist circumference will be measured.

Your blood pressure will be checked, including both systolic (the higher number) and diastolic (the lower number) readings.

Blood tests will measure your HbA1c (glycated hemoglobin), which shows your average blood sugar levels over the past two to three months.

Your blood glucose (blood sugar) levels will be monitored to check for episodes of low blood sugar (hypoglycemia).

Throughout the trial, you will be monitored for any adverse events, which are unwanted or harmful reactions that may occur during treatment.

Any serious adverse events, which are more severe medical problems, will be carefully recorded and assessed.

Special attention will be given to episodes of low blood sugar. Clinically significant low blood sugar is defined as a blood glucose level below 3.0 mmol/L (54 mg/dL) confirmed by a blood glucose meter.

Severe low blood sugar episodes will also be monitored. These are situations where low blood sugar causes confusion or impairment serious enough that you need help from another person to recover.

At the end of the treatment period, final measurements will be taken to compare with your initial measurements from the beginning of the trial.

These final assessments will include all the same measurements taken during your regular monitoring visits, such as kidney function tests, body weight, waist circumference, blood pressure, and blood sugar control.

The information collected throughout the trial will help determine whether the treatment had an effect on kidney disease progression and other health markers.