Contemporary management of advanced chronic kidney disease: An evidence-based review
A clinical review maps the modern toolkit for advanced CKD, covering SGLT2 inhibitors, GLP-1 receptor agonists and finerenone as disease-modifying therapies, tolvaptan for ADPKD, and emerging regenerative approaches including xenotransplantation.
Background
CKD is a major driver of global morbidity and mortality that was traditionally managed with RAS inhibition and supportive care. Recent therapeutic advances have transformed the landscape with targeted interventions across several domains.
Key findings
SGLT2 inhibitors and GLP-1 receptor agonists show robust cardiorenal benefits, with SGLT2 inhibitors now used in CKD and heart failure including non-diabetic populations. Non-steroidal mineralocorticoid receptor antagonists, particularly finerenone, add cardiorenal protection with lower hyperkalaemia risk than steroidal agents. Tolvaptan remains the only approved disease-modifying therapy in ADPKD, and regenerative strategies such as mesenchymal stem-cell therapy and genetically modified pig-kidney xenotransplantation show early promise.
Clinical implications
Internal medicine clinicians and nephrologists are pivotal in identifying appropriate candidates for these therapies and integrating evolving evidence into practice, marking a shift toward precision nephrology in advanced CKD.
Category
Research
Source
European Journal of Internal Medicine
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