Combination Therapy: An Upcoming Paradigm to Improve Kidney and Cardiovascular Outcomes in Chronic Kidney Disease
This review argues that combining SGLT2 inhibitors, GLP-1 receptor agonists, and finerenone delivers additive, complementary kidney and cardiovascular protection in cardiovascular-kidney-metabolic syndrome and is now supported as a treatment approach.
Background
The global burden of CKD has nearly doubled since the 1990s, driven largely by diabetes. CKD, diabetes, obesity, and cardiovascular disease are interrelated and share common risk factors, now grouped as cardiovascular-kidney-metabolic (CKM) syndrome, with cardiovascular and kidney-failure risk rising alongside albuminuria and declining kidney function.
Key findings
SGLT2 inhibitors, GLP-1 receptor agonists, and the nonsteroidal mineralocorticoid receptor antagonist finerenone reduce metabolic, kidney, and cardiovascular risk through complementary mechanisms. Combining an SGLT2 inhibitor with finerenone also lowers the risk of hyperkalemia, and emerging aldosterone synthase inhibitors and endothelin receptor antagonists add antiproteinuric effects on top of RAS and SGLT2 inhibition.
Clinical implications
Current evidence supports combination guideline-directed therapy to achieve additive and potentially synergistic heart and kidney protection; the authors call for raising awareness and building care processes to overcome therapeutic inertia, while several trials continue to test combination regimens.
Category
Transplant
Source
Nephrology Dialysis Transplantation
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