Combination pharmacotherapy in type 2 diabetes and chronic kidney disease: translating evidence into clinical practice

Abstract

ABSTRACT Development of chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM) is a dual threat, imposing not only increased risk for end-stage renal disease but also substantially increasing cardiovascular risk and premature mortality. Its prevalence is staggering, affecting approximately 30%–40% of all patients with T2DM. Fortunately, advances in pharmacotherapies over the past 25 years, including sodium–glucose cotransporter 2 inhibitors, non-steroidal mineralocorticoid receptor antagonists and glucagon-like peptide-1 receptor agonists, together with blockade of renin–angiotensin aldosterone system activation with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, have transformed the clinical management of T2DM and CKD. By providing parallel reductions in both renal and cardiovascular risk, patients with T2DM and CKD (especially those at higher risk) experience improved survival, fewer cardiovascular events and require less initiation of dialysis as a result of delayed progression to end-stage renal failure. Recent evidence from clinical trials in T2DM and CKD supports simultaneous use of combinatory pharmacotherapies targeting distinct mechanistic pathophysiological pathways.