Recent evidence for reducing cardiometabolic risk in chronic kidney disease

Chronic kidney disease (CKD) and cardiovascular disease (CVD) frequently coexist, with an increasing risk of CVD as kidney function declines. Therefore, effective cardiovascular risk management is an essential part of the clinical care of patients with CKD. This article summarizes recent evidence of cardiovascular risk reduction in clinical trials of patients with CKD, focusing on sodium-glucose cotransporter-2 inhibitors (SGLT2i), in addition to mineralocorticoid receptor antagonists (MRAs) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs). On the basis of current evidence, practice guidelines from 'Kidney Disease: Improving Global Outcomes (KDIGO 2024)' recommend the use of SGLT2i for patients with estimated glomerular filtration rate (eGFR) >20 mL/min/1.73 m². The 2025 guidelines from the American Diabetes Association (ADA) also recommend SGLT2i for people with T2D and CKD (eGFR ≥20 mL/min/1.73 m²) to reduce the risk of CKD progression and cardiovascular events. At present, finerenone is the only nonsteroidal MRA with evidence of cardiovascular and renal benefits in patients with CKD and T2D, and the use of this agent is recommended for patients with T2D at high risk of CKD progression and cardiovascular events. Cardiorenal protective effects have been observed with GLP-1 RAs. The ADA recommends a GLP-1 RA with demonstrated benefit in reducing cardiovascular risk and kidney disease progression for patients with CKD and T2D. A combination of SGLT2i, GLP-1 RAs, and nonsteroidal MRA may be considered for management of patients with CKD and T2D. Overall, a holistic, multidisciplinary approach to the care of people with CKD is recommended. This may involve multiple disease specialists, including cardiologists, nephrologists, endocrinologists, primary care physicians, and other healthcare professionals in the medical team. Clinicians have a key role in ensuring the implementation of evidence-based therapies for patients with CKD, with the ultimate aim of slowing progression of CKD, reducing metabolic complications, and improving cardiovascular outcomes.