Advances in therapy

Recommended Treatments That May Slow Disease Progression in Patients with Heart and Kidney Problems

Updated

Abstract

Suboptimal dosing of renin-angiotensin system inhibitors (RASi) in chronic kidney disease (CKD) may increase the risk of adverse events and mortality.

  • Gaps exist between recommended guideline-directed medical therapy (GDMT) for CKD and actual clinical practice.
  • Low uptake of sodium-glucose co-transporter 2 inhibitors (SGLT2i) may be linked to concerns about disease progression.
  • Novel potassium binders can help manage hyperkalemia, allowing for optimal dosing of RASi.
  • Clinical trials indicate that combining SGLT2i with RASi therapy can lead to improved outcomes and prolonged survival in CKD.
  • The 2024 KDIGO guidelines recommend SGLT2i for CKD patients without diabetes and emphasize the importance of optimizing RASi therapy.

Simplified

Key numbers

840 million
Prevalence of
Estimated number of individuals affected by chronic kidney disease globally.
44–81%
Uptake
Percentage of patients receiving renin-angiotensin system inhibitors.
19–26%
Maximum Dose Adherence
Percentage of patients receiving the maximum tolerated dose of .

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Funding

Competing interests

Declarations. Conflict of Interest: Christoph Wanner reports receiving honoraria for steering committee and advisory board participation, and lecturing from Alexion, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, CSL Vifor, Eli Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk, and Sanofi. Ming-Hui Zhao reports receiving honoraria for advisory boards and consulting fees from AstraZeneca, BeiGene, Kira, Novartis, Roche, and SanReno. Alpesh N. Amin was principal investigator or co-investigator of clinical trials sponsored by Alexion, Aseptiscope, Blade Therapeutics, Eli Lilly, Fulcrum Therapeutics, Humanigen, NeuroRx Pharma, National Institutes of Health/National Institute of Allergy and Infectious Diseases, Novartis, OctaPharma, PTC Therapeutics, Pulmotect, and Takeda; and speaker and/or consultant for Alexion, AstraZeneca, Bayer, Dexcom, Eli Lilly, Ferring, Gilead, GSK, HeartRite, Novo Nordisk, Pfizer, Renibus, Reprieve, Salix, Seres, and Spero (unrelated to this manuscript). Luca De Nicola reports receiving honoraria for participation on advisory boards and lectures from Astellas, AstraZeneca, Bayer, and Novo Nordisk. Andrew J. Sauer reports receiving research funding support from AstraZeneca, Bayer, Boehringer Ingelheim, CSL Vifor, Edwards Lifesciences, Heart Failure Society of America, Novo Nordisk, Pfizer, 35Pharma, Rivus Pharmaceuticals, and Story Health; consultancy fees from Abbott, Acorai, Amgen, Bayer, Boston Scientific, Edwards Lifesciences, General Prognostics, Impulse Dynamics, and Story Health; and stock ownership in ISHI and Pulsli (privately held digital health companies). Alaster M. Allum, Unai Aranda, and You-Seon Nam are employees of, and may hold stock and/or stock options in, AstraZeneca. Javed Butler reports receiving consultancy fees from Abbott, American Regent, Amgen, Applied Therapeutic, AskBio, Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Cardiac Dimension, Cardior, CSL Bering, CVRx, Cytokinetics, Edwards Lifesciences, Element Science, Faraday, Foundry, Innolife, Impulse Dynamics, Imbria, Inventiva, Ionis, Lexicon, Lilly, LivaNova, Janssen, Medtronics, Merck, Occlutech, Owkin, Novartis, Novo Nordisk, Pfizer, Pharmacosmos, Pharmain, Prolaio, Regeneron, Renibus, Roche, Salamandra, Sanofi, SC Pharma, Secretome, Sequana, SQ Innovation, Tenex, Tricog, Ultromics, Vifor, and Zoll. Ethical Approval: This article is based on previously conducted studies and does not contain any new studies with human participants or animals that were performed by any of the authors.
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