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Example 20 preparation of Semetreuptade 62.6 g of the peptide resin obtained in example 16 was charged into a 2000ml single-neck flask, and a lysate of 650ml of TFA was prepared: and (3) TIS: EDT (electro-thermal transfer coating): PhOH: H2O 90:3:3:2:2 (vol.%), the lysate was added to the flask, the reaction was carried out at room temperature for 2.5 hours, the resin was filtered off, the resin was washed with 50ml tfa, the filtrates were combined, the resulting mixture was added to 6500ml of anhydrous ether to precipitate a white solid, the solid was centrifuged, washed with anhydrous ether, and 21.02 g of crude semaglutide peptide was dried in vacuo to a white solid, with a yield of 102.13%

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Stage 2: Kidney function starts to decline (GFR between 60 and 89), but symptoms are usually absent