The prevention and management of chronic kidney disease among patients with metabolic syndrome

Feb 22, 2025Kidney international

Preventing and Managing Long-Term Kidney Disease in People with Metabolic Syndrome

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Abstract

Five pharmacotherapies have been proven to be nephroprotective and/or cardioprotective for certain types of patients with chronic kidney disease (CKD).

Metabolic syndrome, characterized by obesity, high blood pressure, dyslipidemia, and hyperglycemia, is common among CKD patients.
Renin-angiotensin system inhibitors and sodium-glucose cotransporter 2 inhibitors are associated with slower kidney disease progression and reduced heart failure complications.
Statin-based regimens lower low-density lipoprotein cholesterol but have no clinically meaningful effect on kidney outcomes.
In patients with type 2 diabetes and albuminuric CKD, finerenone and semaglutide may provide cardiorenal benefits, with semaglutide also effective in reducing weight.
The evidence suggests that metabolic syndrome may mediate some of the cardiorenal risks in CKD, influencing kidney disease progression and cardiovascular outcomes.

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Treatment of patients with chronic kidney disease (CKD) requires implementation of prevention and management strategies that reduce the risk of kidney failure and CKD-associated cardiovascular risk. Metabolic syndrome is characterized by obesity, high blood pressure, dyslipidemia, and hyperglycemia, and it is common among patients with CKD. Large-scale randomized trials have led to significant advances in the management of CKD, with 5 pharmacotherapies now proven to be nephroprotective and/or cardioprotective in certain types of patients. Renin-angiotensin system inhibitors and sodium-glucose cotransporter 2 inhibitors slow kidney disease progression and reduce heart failure complications for most patients with CKD. In addition, statin-based regimens reduce low-density lipoprotein cholesterol and lower the risk of atherosclerotic disease (with no clinically meaningful effect on kidney outcomes). For patients with type 2 diabetes and albuminuric CKD, the nonsteroidal mineralocorticoid receptor antagonist finerenone and the glucagon-like peptide-1 receptor agonist semaglutide also confer cardiorenal benefits, with semaglutide additionally effective at reducing weight. Together, these randomized data strongly suggest that metabolic syndrome mediates some of the cardiorenal risk observed in CKD. Considered separately, the trials help elucidate which components of metabolic syndrome influence the pathophysiology of kidney disease progression and which separately modify risk of atherosclerotic and nonatherosclerotic cardiovascular outcomes. As we predict complementary and different mechanisms of nephroprotection and cardioprotection for these different interventions, it seems logical that they should be deployed together to maximize benefits. Even when combined, however, these therapies are not a cure, so further trials remain important to reduce the residual cardiorenal risks associated with CKD.

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The prevention and management of chronic kidney disease among patients with metabolic syndrome

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