The evolution of "pillars of therapy" to reduce heart failure risk and slow diabetic kidney disease progression

Area of Science:

• Nephrology
• Cardiology
• Endocrinology

Background:

• Chronic kidney disease (CKD) progression has seen significant therapeutic evolution.
• Traditional renal sparing therapy involved renin-angiotensin system (RAS) blockers.

Purpose of the Study:

• To outline the current and future landscape of therapies for slowing CKD progression.
• To highlight the cardiorenal benefits of novel therapeutic agents.

Main Methods:

• Review of recent advancements in pharmacological interventions for CKD.
• Analysis of clinical trial data for SGLT2 inhibitors and finerenone in CKD patients with type 2 diabetes.

Main Results:

• A combination of RAS blockers, SGLT2 inhibitors, and finerenone slows CKD progression by over 50% compared to RAS blockers alone.
• Finerenone and SGLT2 inhibitors reduce heart failure hospitalizations and cardiovascular death.
• These agents improve exercise tolerance but do not impact atherosclerotic heart disease.

Conclusions:

• A "three pillar" therapy approach combining RAS blockers, SGLT2 inhibitors, and finerenone is effective for cardiorenal risk reduction.
• This strategy is beneficial for patients with type 2 diabetes and any stage of kidney disease.
• Future therapeutic strategies will likely build upon these advancements.