Optimizing kidney and cardiovascular protection in an era of multiple effective treatments

Taal, Maarten W.

Abstract

Purpose of review After decades of relying on the control of hypertension and treatment with renin angiotensin system inhibitors as the only evidence-based interventions to slow the progression of chronic kidney disease (CKD), we have entered an era when multiple effective treatment options are available. This review considers the mechanisms and benefits of these novel treatments as well as the challenges associated with achieving optimal combination therapy. Recent findings Over the past 5 years, large clinical trials have provided robust evidence that, when added to renin angiotensin system inhibitors, treatment with sodium glucose cotransporter 2 inhibitors reduces the rate of CKD progression and the risk of cardiovascular events in people with CKD with or without diabetes and with or without albuminuria; nonsteroidal mineralocorticoid antagonists and glucagon-like peptide-1 receptor agonists afford similar benefits in people with type 2 diabetes and CKD. The mechanisms of actions of these novel therapies suggest that combination therapy will produce additive benefits, though specific evidence is sparse. Summary Further trials are warranted to investigate the benefits of combination therapy with novel treatments in people with CKD. Clinical implementation of optimal combination therapy will require reorganization of services to ensure that patients receive adequate education, support and monitoring.

Citation

Taal, M. W. (2024). Optimizing kidney and cardiovascular protection in an era of multiple effective treatments. Current Opinion in Nephrology and Hypertension, 33(6), 551-556. https://doi.org/10.1097/MNH.0000000000001019

• Journal Article Type: Review
• Acceptance Date: Aug 2, 2024
• Online Publication Date: Aug 14, 2024
• Publication Date: 2024-11
• Deposit Date: Aug 5, 2024
• Publicly Available Date: Aug 15, 2025
• Journal: Current Opinion in Nephrology and Hypertension
• Print ISSN: 1062-4821
• Electronic ISSN: 1473-6543
• Publisher: Lippincott, Williams & Wilkins
• Peer Reviewed: Peer Reviewed
• Volume: 33
• Issue: 6
• Pages: 551-556
• DOI: https://doi.org/10.1097/MNH.0000000000001019
• Public URL: https://nottingham-repository.worktribe.com/output/38104887
• Publisher URL: https://journals.lww.com/co-nephrolhypertens/abstract/9900/optimizing_kidney_and_cardiovascular_protection_in.179.aspx