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Preventing and treating kidney disease in patients with type 2 diabetes

Pierre Delanaye1, André J Scheen2,3

  • 1a Division of Nephrology, Dialysis and Transplantation, Department of Medicine , Liège , Belgium.

Expert Opinion on Pharmacotherapy
|November 22, 2018
PubMed
Abstract

Insights

New glucose-lowering drugs, including SGLT2 inhibitors and GLP-1 RAs, offer significant kidney protection for type 2 diabetes patients. Combining these with RAAS inhibitors may further improve renal outcomes.

Area of Science:

  • Nephrology
  • Endocrinology
  • Pharmacology

Background:

  • Chronic kidney disease (CKD) poses a significant health burden for individuals with type 2 diabetes (T2DM).
  • Renin-angiotensin-aldosterone system (RAAS) inhibitors are standard for nephroprotection in T2DM with albuminuria.

Purpose of the Study:

  • To assess the added renal benefits of novel glucose-lowering agents when used alone or with RAAS inhibitors in T2DM patients.
  • To review current and emerging therapeutic strategies for managing CKD in T2DM.

Main Methods:

  • Review of existing literature on RAAS inhibitors, GLP-1 receptor agonists (GLP-1RAs), and sodium-glucose cotransporter type 2 inhibitors (SGLT2is).
  • Analysis of studies reporting effects on renal outcomes, including surrogate and hard endpoints.
  • Consideration of potential mechanisms and complementary effects of combined therapies.

Main Results:

  • RAAS inhibitors provide renoprotection beyond blood pressure control.
  • SGLT2is and GLP-1RAs demonstrate significant nephroprotective effects, potentially independent of glucose lowering.
  • Evidence supports benefits on albuminuria, estimated glomerular filtration rate (eGFR) decline, and progression to end-stage renal disease (ESRD).

Conclusions:

  • Combined therapies with RAAS inhibitors and new glucose-lowering agents may offer synergistic renoprotection.
  • Different mechanisms of action suggest complementary roles in managing glomerular hemodynamics.
  • Further research into novel agents is warranted to address the unmet needs in T2DM-related CKD.
Keywords:
Chronic kidney diseaseGLP-1 receptor agonistRAS inhibitorsSGLT2 inhibitorType 2 diabetes

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