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[Conservative Therapy in CKD: New Frontiers].

Chiara Ruotolo¹, Giuseppe Gigliotti², Federica Marzano¹

¹Nefrologia e Dialisi, Dipartimento di Scienze Mediche Chirurgiche Avanzate, Università degli studi della Campania "L. Vanvitelli", Napoli.

Giornale Italiano Di Nefrologia : Organo Ufficiale Della Societa Italiana Di Nefrologia

|February 11, 2025

Summary

Combination therapy using Renin-Angiotensin-Aldosterone System inhibitors (RAASi) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) effectively slows chronic kidney disease (CKD) progression. Further agents like GLP-1 RAs and MRAs offer additional cardiorenal protection.

Keywords:

CKD ERAs GLP-1 RA MRAs RAASi SGLT-2i cardiovascular risk diabetes mellitus proteinuria

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Area of Science:

Nephrology
Cardiology
Pharmacology

Context:

Chronic kidney disease (CKD) prevalence is rising globally due to aging populations, obesity, diabetes, and hypertension.
Current treatment strategies focus on slowing CKD progression and reducing cardiovascular events.
Combination therapy with Renin-Angiotensin-Aldosterone System inhibitors (RAASi) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) is a cornerstone of management.

Purpose:

To outline updated guidelines and therapeutic strategies for managing chronic kidney disease (CKD) and associated cardiorenal risks.
To highlight the role of combination therapies and newer drug classes in personalized treatment approaches.
To emphasize the synergistic potential of combining multiple drug classes for enhanced cardiorenal protection.

Summary:

Updated guidelines recommend a tailored, multi-drug approach for CKD management, prioritizing RAASi and SGLT-2i as first-line therapies.
Additional agents, including GLP-1 receptor agonists (GLP-1 RA) and non-steroidal mineralocorticoid receptor antagonists (MRAs), are advised for enhanced cardiorenal protection.
Emerging drug classes like Endothelin Receptor Antagonists (ERAs) demonstrate antiproteinuric and nephroprotective benefits, supporting combination strategies.

Impact:

Personalized therapeutic strategies combining multiple drug classes can act synergistically on different pathways to improve patient outcomes.
This approach aims to slow CKD progression and reduce the incidence of cardiovascular events in high-risk individuals.
The integration of novel therapies like ERAs offers new avenues for optimizing cardiorenal protection in CKD patients.