Study shows SGLT2i or Finerenone Added to RAAS Inhibitors Offers Kidney and Heart Protection for Diabetics with CKD
Type 2 diabetes (T2D) is the leading cause of end-stage kidney disease (ESKD) globally. The presence of both T2D and CKD poses a major public health challenge because patients are at an increased risk of cardiovascular (CV) events and related mortality compared with patients with either condition alone. According to a new research published in BMC Nephrology, adding SGLT2i or finerenone to RAAS inhibitors may provide kidney and CV protection in diabetics with CKD.
Given the substantial burden of chronic kidney disease associated with type 2 diabetes, an aggressive approach to treatment is required. Despite the benefits of guideline-directed therapy, there remains a high residual risk of continuing progression of chronic kidney disease and of cardiovascular events.
Historically, a linear approach to pharmacologic management of chronic kidney disease has been used, in which drugs are added, then adjusted, optimized, or stopped in a stepwise manner based on their efficacy, toxicity, effects on a patient’s quality of life, and cost. However, there are disadvantages to this approach, which may result in missing a window of opportunity to slow chronic kidney disease progression. Instead, a pillar approach has been proposed to enable earlier treatment that simultaneously targets multiple pathways involved in disease progression.
Combination therapy in patients with chronic kidney disease associated with type 2 diabetes is being investigated in several clinical trials. Inclusion of either an SGLT2i or finerenone to a maximum tolerated dose of a RAAS inhibitor provides supportive phase 3 evidence of a pillar approach. The pillar approach if adopted in routine clinical practice in CKD would enable drugs of different classes to be combined and taken earlier in the disease course, which may have greater benefit as the extent of pathophysiologic damage is likely to be lower at an early CKD stage.
Reference: Khan, M.S., Lea, J.P. Kidney and cardiovascular-protective benefits of combination drug therapies in chronic kidney disease associated with type 2 diabetes. BMC Nephrol 25, 248 (2024). https://doi.org/10.1186/s12882-024-03652-5
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