Slowing the Progression of Chronic Kidney Disease in Patients with Type 2 Diabetes Using Four Pillars of Therapy: The Time to Act is Now

Sep 11, 2024Drugs

Slowing Kidney Disease in Type 2 Diabetes Patients Using Four Key Treatments

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Abstract

Large phase 3 clinical trials have shown that sodium-glucose co-transporter type 2 (SGLT-2) inhibitors, finerenone, and semaglutide provide additive cardiorenal protective benefits in patients with albuminuric chronic kidney disease (CKD) and type 2 diabetes (T2D).

Chronic kidney disease is a major complication for patients with type 2 diabetes, worsening their risk of premature death and heart issues.
Traditional treatment focused on blocking the renin-angiotensin system, but newer therapies have emerged in the last five years.
SGLT-2 inhibitors, finerenone, and semaglutide have been shown to work better than standard treatments when used alongside RAS blockers.
The potential benefits of using these therapies together are still being investigated in ongoing clinical trials.
This article outlines four key treatment strategies aimed at reducing residual risks for heart and kidney problems in high-risk patients.

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Chronic kidney disease (CKD) is the most common co-morbidity in patients with type 2 diabetes (T2D) and its presence substantially amplifies the risk for premature death, adverse cardiovascular events, and faster progression of kidney injury to kidney failure. For nearly two decades, the pharmacological blockade of the renin-angiotensin-system (RAS) was the only pillar of therapy to afford cardiorenal protection in these patients. During the last 5 years, newer novel therapies have been added to our therapeutic armamentarium, offering promise for more effective management of diabetic kidney disease in the future. Large phase 3 clinical trials have demonstrated additive cardiorenal protective benefits of sodium-glucose co-transporter type 2 (SGLT-2) inhibitors, the non-steroidal mineralocorticoid-receptor-antagonist (MRA) finerenone, and glucagon-like peptide-1 receptor agonist (GLP-1RA) semaglutide relative to placebo in patients with albuminuric CKD and T2D who are receiving standard-of-care treatment with a RAS-blocker. These therapies are likely much more effective when administered in a combined therapeutic algorithm, but the potential additive effects of combination therapy remain to be established in ongoing clinical trials. In this article, we assemble four pillars of therapy for the attenuation of residual cardiorenal risk in patients with CKD associated with T2D. We provide evidence from recent randomized trials and we discuss the concept of combined treatment for maximal cardiorenal protection in this high-risk patient population.

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Slowing the Progression of Chronic Kidney Disease in Patients with Type 2 Diabetes Using Four Pillars of Therapy: The Time to Act is Now

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