Current options for slowing the progression of chronic kidney disease

Area of Science:

• Nephrology
• Pharmacology
• Internal Medicine

Background:

• Chronic kidney disease (CKD) often progresses to end-stage renal disease, necessitating renal replacement therapy.
• The renin-angiotensin-aldosterone system (RAAS) plays a crucial role in CKD progression.
• Current therapies aim to slow CKD progression by targeting RAAS.

Purpose of the Study:

• To review current and emerging therapeutic strategies for slowing the progression of chronic kidney disease.
• To highlight the role of RAAS blockade and novel agents in managing renal insufficiency.

Main Methods:

• Review of current pharmacological interventions for CKD.
• Analysis of emerging treatments including SGLT2 inhibitors and mineralocorticoid receptor antagonists.
• Inclusion of lifestyle interventions such as exercise.

Main Results:

• Angiotensin converting enzyme (ACE) inhibitors and angiotensin II type 1 receptor blockers (ARBs) significantly slow CKD progression by blocking RAAS.
• Sodium glucose cotransporter 2 (SGLT2) inhibitors, such as dapagliflozin, offer an additional strategy to enhance RAAS blockade effects.
• Finerenone, a mineralocorticoid receptor antagonist, is an upcoming treatment expected to further potentiate ACE/ARB inhibitor efficacy.
• Exercise has emerged as a viable non-pharmacological method to influence renal insufficiency progression.

Conclusions:

• Combining RAAS blockade with SGLT2 inhibitors or finerenone represents a promising therapeutic approach for managing CKD.
• Dapagliflozin is available for diabetic and non-diabetic kidney disease, with finerenone anticipated soon.
• Exercise offers a complementary strategy to pharmacological treatments for slowing CKD progression.