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Review
. 2022 Sep 1;31(5):456-463.
doi: 10.1097/MNH.0000000000000811. Epub 2022 Jul 18.

Progress in the management of patients with diabetes and chronic kidney disease

Leonardo Pozo Garcia  1 , Sandhya S Thomas  1   2 , Harsith Rajesh  3 , Sankar D Navaneethan  1   2   4   5
Affiliations
Review

Progress in the management of patients with diabetes and chronic kidney disease

Leonardo Pozo Garcia et al. Curr Opin Nephrol Hypertens. .

Abstract

Purpose of review: Diabetic kidney disease is the most common cause of chronic kidney disease (CKD) and end-stage kidney disease in the world. Risk factor modification, glucose control, and renin-angiotensin-aldosterone system blockade have remained the standard of care for 2 decades. New therapeutic agents have emerged in recent years, demonstrating kidney and cardiovascular benefits, and herein we review recent clinical trials on this topic.

Recent findings: After the publication of several cardiovascular outcome trials for sodium-glucose cotransporter 2 inhibitors (SGLT-2i), new trials have focused ON primary kidney-specific outcomes demonstrating safety and benefits among patients with proteinuric CKD; patients with or without diabetes, and heart failure with preserved ejection fraction (HFpEF) respectively. Similarly, nonsteroidal mineralocorticoid receptor antagonists (ns-MRAs) and glucagon-like-peptide 1 receptor agonists (GLP-1 RAs) have improved cardiovascular and kidney outcomes. Recently, clinical practice guidelines have also been updated to reflect this new evidence.

Summary: In summary, SGLT-2i, GLP-1 RAs, and ns-MRAs have demonstrated cardiovascular and kidney benefits, including all-cause and cardiovascular mortality, progression to end-stage kidney disease, and hospitalizations for heart failure exacerbation among diverse patient population.

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