| Summary: | The evolution of therapy to slow chronic kidney disease progression has changed dramatically over the last five years and is anticipated to change even more in the coming two to four years. What was traditionally noted as “renal sparing therapy” with blockers of the renin-angiotensin system (RAS) has now expanded to the use of inhibitors of sodium-glucose transport 2 (SGLT2) agents as well as the nonsteroidal mineralocorticoid receptor blocker, finerenone. These three “pillars of therapy” have slowed kidney disease progression by more than 50% compared to RAS blockers alone. Additionally, finerenone and SGLT2 inhibitors significantly reduce heart failure hospitalizations and the development of heart failure. Moreover, they improve exercise tolerance and reduce the risk of cardiovascular death, even though they do not affect atherosclerotic heart disease development. These data, taken together, demonstrate a “three pillar” therapy approach for cardiorenal risk reduction in people with type 2 diabetes who have any level of kidney disease.
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