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Combination therapy with kidney protective therapies: optimizing the benefits?
Sradha Kotwal1,2, Evan Perkovic3, Vlado Perkovic1,4
1The George Institute for Global Health, UNSW, Sydney, NSW 2052, Australia.
Purpose Of Review:
Recent advances in the treatment of chronic kidney disease (CKD) have led to the development of several new agents that are kidney protective, particularly in people with diabetes. These agents include sodium/glucose cotransporter-2 inhibitors (SGLT-2 inhibitors), mineralocorticoid receptor antagonists (MRAs), and glucagon-like peptide-1 receptor agonists (GLP-1RAs). This review summarizes the available data regarding the effects of using these therapies in combination.
Recent Findings:
There is convincing evidence that SGLT-2 inhibitors and MRAs individually improve kidney function and reduce the risk of cardiovascular events in people with CKD, especially diabetic CKD. There is some evidence that GLP-1RAs may be beneficial, but further studies are needed.The available data support an additive kidney and cardiovascular benefit using combination therapy with SGLT-2 inhibitors and MRAs, and possibly with SGLT2 inhibitors and GLP-1RAs, but more long-term data are needed. The currently available data suggest that combining these agents would likely be beneficial and may be an appropriate long-term strategy.
Summary:
Several new agents are useful in slowing the progress of CKD. Further research to identify which combinations of agents work best together and which combinations are most effective for people with different characteristics, in order to personalize treatment and improve outcomes for people with CKD, should be a priority.
Insights
New kidney protective agents, including SGLT-2 inhibitors and MRAs, show combined benefits for chronic kidney disease (CKD) patients, particularly those with diabetes. Further research is needed to optimize combination therapies for personalized CKD treatment.
Area of Science:
- Nephrology
- Pharmacology
- Cardiology
Background:
- Chronic kidney disease (CKD) management has advanced with new kidney-protective agents.
- Agents like SGLT-2 inhibitors, MRAs, and GLP-1RAs offer potential benefits, especially for diabetic CKD.
- This review focuses on the combined effects of these novel therapeutic agents.
Approach:
- Summarizing existing data on combination therapies for CKD.
- Evaluating the efficacy of SGLT-2 inhibitors, MRAs, and GLP-1RAs individually and in combination.
- Assessing the impact on kidney function and cardiovascular events.
Key Points:
- SGLT-2 inhibitors and MRAs individually demonstrate significant kidney and cardiovascular benefits in CKD, particularly diabetic CKD.
- Combination therapy with SGLT-2 inhibitors and MRAs appears to offer additive benefits.
- GLP-1RAs may provide additional benefits, but more research is required.
- Long-term data on combination therapies are still needed.
Conclusions:
- Current evidence suggests that combining SGLT-2 inhibitors and MRAs is likely beneficial for CKD patients.
- Combination therapy may represent an appropriate long-term strategy for managing CKD.
- Personalized treatment strategies through further research into optimal combinations are crucial for improving CKD outcomes.
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