Combination therapy with kidney protective therapies: optimizing the benefits?

Purpose of reviewRecent advances in the treatment of chronic kidney disease (CKD) have led to the development of several new agents that are kidney protective, particularly in people with diabetes. These agents include sodium/glucose cotransporter-2 inhibitors (SGLT-2 inhibitors), mineralocorticoid receptor antagonists (MRAs), and glucagon-like peptide-1 receptor agonists (GLP-1RAs). This review summarizes the available data regarding the effects of using these therapies in combination.There is convincing evidence that SGLT-2 inhibitors and MRAs individually improve kidney function and reduce the risk of cardiovascular events in people with CKD, especially diabetic CKD. There is some evidence that GLP-1RAs may be beneficial, but further studies are needed.The available data support an additive kidney and cardiovascular benefit using combination therapy with SGLT-2 inhibitors and MRAs, and possibly with SGLT2 inhibitors and GLP-1RAs, but more long-term data are needed. The currently available data suggest that combining these agents would likely be beneficial and may be an appropriate long-term strategy.Several new agents are useful in slowing the progress of CKD. Further research to identify which combinations of agents work best together and which combinations are most effective for people with different characteristics, in order to personalize treatment and improve outcomes for people with CKD, should be a priority.Papers of particular interest, published within the annual period of review, have been highlighted as:Chronic kidney disease (CKD) is a slowly progressive disease that affects almost 10% of the world's population [1]. CKD increases the risk of kidney failure, cardiovascular disease, and death. Slowing the progression of kidney disease in the absence of the capacity to halt the progression or 'cure' the disease is crucial. Treatment has traditionally focused on lifestyle changes and the use of renin-angiotensin-aldosterone system (RAAS) inhibitors to slow progression and reduce the risk of cardiovascular events, given the absence until recently of other treatments clearly proven to improve outcomes for people with CKD. Although combining agents with different mechanisms of action has been routine for people with hypertension, cardiovascular disease, and heart failure, the lack of treatments has limited application in people with CKD to date. However, recent advances in therapy have created the opportunity for combination therapies to slow progression. Here, we provide an overview of recent developments that have changed the standard of care for CKD, with a focus on summarizing available data regarding the effects of combination therapy with newer classes of kidney protective agents. no caption availablePurpose of reviewRecent advances in the treatment of chronic kidney disease (CKD) have led to the development of several new agents that are kidney protective, particularly in people with diabetes. These agents include sodium/glucose cotransporter-2 inhibitors (SGLT-2 inhibitors), mineralocorticoid receptor antagonists (MRAs), and glucagon-like peptide-1 receptor agonists (GLP-1RAs). This review summarizes the available data regarding the effects of using these therapies in combination.There is convincing evidence that SGLT-2 inhibitors and MRAs individually improve kidney function and reduce the risk of cardiovascular events in people with CKD, especially diabetic CKD. There is some evidence that GLP-1RAs may be beneficial, but further studies are needed. The available data support an additive kidney and cardiovascular benefit using combination therapy with SGLT-2 inhibitors and MRAs, and possibly with SGLT2 inhibitors and GLP-1RAs, but more long-term data are needed. The currently available data suggest that combining these agents would likely be beneficial and may be an appropriate long-term strategy.Several new agents are useful in slowing the progress of CKD. Further research to identify which combinations of agents work best together and which combinations are most effective for people with different characteristics, in order to personalize treatment and improve outcomes for people with CKD, should be a priority.Papers of particular interest, published within the annual period of review, have been highlighted as:Chronic kidney disease (CKD) is a slowly progressive disease that affects almost 10% of the world's population [1]. CKD increases the risk of kidney failure, cardiovascular disease, and death. Slowing the progression of kidney disease in the absence of the capacity to halt the progression or 'cure' the disease is crucial. Treatment has traditionally focused on lifestyle changes and the use of renin-angiotensin-aldosterone system (RAAS) inhibitors to slow progression and reduce the risk of cardiovascular events, given the absence until recently of other treatments clearly proven to improve outcomes for people with CKD. Although combining agents with different mechanisms of action has been routine for people with hypertension, cardiovascular disease, and heart failure, the lack of treatments has limited application in people with CKD to date. However, recent advances in therapy have created the opportunity for combination therapies to slow progression. Here, we provide an overview of recent developments that have changed the standard of care for CKD, with a focus on summarizing available data regarding the effects of combination therapy with newer classes of kidney protective agents. no caption availablePurpose of reviewRecent advances in the treatment of chronic kidney disease (CKD) have led to the development of several new agents that are kidney protective, particularly in people with diabetes. These agents include sodium/glucose cotransporter-2 inhibitors (SGLT-2 inhibitors), mineralocorticoid receptor antagonists (MRAs), and glucagon-like peptide-1 receptor agonists (GLP-1RAs). This review summarizes the available data regarding the effects of using these therapies in combination.There is convincing evidence that SGLT-2 inhibitors and MRAs individually improve kidney function and reduce the risk of cardiovascular events in people with CKD, especially diabetic CKD. There is some evidence that GLP-1RAs may be beneficial, but further studies are needed.The available data support an additive kidney and cardiovascular benefit using combination therapy with SGLT-2 inhibitors and MRAs, and possibly with SGLT2 inhibitors and GLP-1RAs, but more long-term data are needed. The currently available data suggest that combining these agents would likely be beneficial and may be an appropriate long-term strategy.Several new agents are useful in slowing the progress of CKD. Further research to identify which combinations of agents work best together and which combinations are most effective for people with different characteristics, in order to personalize treatment and improve outcomes for people with CKD, should be a priority. Papers of particular interest, published within the annual period of review, have been highlighted as:Chronic kidney disease (CKD) is a slowly progressive disease that affects almost 10% of the world's population [1]. CKD increases the risk of kidney failure, cardiovascular disease, and death. Slowing the progression of kidney disease in the absence of the capacity to halt the progression or 'cure' the disease is crucial. Treatment has traditionally focused on lifestyle changes and the use of renin-angiotensin-aldosterone system (RAAS) inhibitors to slow progression and reduce the risk of cardiovascular events, given the absence until recently of other treatments clearly proven to improve outcomes for people with CKD. Although combining agents with different mechanisms of action has been routine for people with hypertension, cardiovascular disease, and heart failure, the lack of treatments has limited application in people with CKD to date. However, recent advances in therapy have created the opportunity for combination therapies to slow progression. Here, we provide an overview of recent developments that have changed the standard of care for CKD, with a focus on summarizing available data regarding the effects of combination therapy with newer classes of kidney protective agents. no caption availablePurpose of reviewRecent advances in the treatment of chronic kidney disease (CKD) have led to the development of several new agents that are kidney protective, particularly in people with diabetes. These agents include sodium/glucose cotransporter-2 inhibitors (SGLT-2 inhibitors), mineralocorticoid receptor antagonists (MRAs), and glucagon-like peptide-1 receptor agonists (GLP-1RAs). This review summarizes the available data regarding the effects of using these therapies in combination.There is convincing evidence that SGLT-2 inhibitors and MRAs individually improve kidney function and reduce the risk of cardiovascular events in people with CKD, especially diabetic CKD. There is some evidence that GLP-1RAs may be beneficial, but further studies are needed.The available data support an additive kidney and cardiovascular benefit using combination therapy with SGLT-2 inhibitors and MRAs, and possibly with SGLT2 inhibitors and GLP-1RAs, but more long-term data are needed. The currently available data suggest that combining these agents would likely be beneficial and may be an appropriate long-term strategy.Several new agents are useful in slowing the progress of CKD. Further research to identify which combinations of agents work best together and which combinations are most effective for people with different characteristics, in order to personalize treatment and improve outcomes for people with CKD, should be a priority.Papers of particular interest, published within the annual period of review, have been highlighted as:Chronic kidney disease (CKD) is a slowly progressive disease that affects almost 10% of the world's population [1]. CKD increases the risk of kidney failure, cardiovascular disease, and death. Slowing the progression of kidney disease in the absence of the capacity to halt the progression or 'cure' the disease is crucial. Treatment has traditionally focused on lifestyle changes and the use of renin-angiotensin-aldosterone system (RAAS) inhibitors to slow progression and reduce the risk of cardiovascular events, given the absence until recently of other treatments clearly proven to improve outcomes for people with CKD. Although combining agents with different mechanisms of action has been routine for people with hypertension, cardiovascular disease, and heart failure, the lack of treatments has limited application in people with CKD to date. However, recent advances in therapy have created the opportunity for combination therapies to slow progression. Here, we provide an overview of recent developments that have changed the standard of care for CKD, with a focus on summarizing available data regarding the effects of combination therapy with newer classes of kidney protective agents. no caption availablePurpose of reviewRecent advances in the treatment of chronic kidney disease (CKD) have led to the development of several new agents that are kidney protective, particularly in people with diabetes. These agents include sodium/glucose cotransporter-2 inhibitors (SGLT-2 inhibitors), mineralocorticoid receptor antagonists (MRAs), and glucagon-like peptide-1 receptor agonists (GLP-1RAs). This review summarizes the available data regarding the effects of using these therapies in combination.There is convincing evidence that SGLT-2 inhibitors and MRAs individually improve kidney function and reduce the risk of cardiovascular events in people with CKD, especially diabetic CKD. There is some evidence that GLP-1RAs may be beneficial, but further studies are needed.The available data support an additive kidney and cardiovascular benefit using combination therapy with SGLT-2 inhibitors and MRAs, and possibly with SGLT2 inhibitors and GLP-1RAs, but more long-term data are needed. The currently available data suggest that combining these agents would likely be beneficial and may be an appropriate long-term strategy.Several new agents are useful in slowing the progress of CKD. Further research to identify which combinations of agents work best together and which combinations are most effective for people with different characteristics, in order to personalize treatment and improve outcomes for people with CKD, should be a priority.Papers of particular interest, published within the annual period of review, have been highlighted as:Chronic kidney disease (CKD) is a slowly progressive disease that affects almost 10% of the world's population [1]. CKD increases the risk of kidney failure, cardiovascular disease, and death. Slowing the progression of kidney disease in the absence of the capacity to halt the progression or 'cure' the disease is crucial. Treatment has traditionally focused on lifestyle changes and the use of renin-angiotensin-aldosterone system (RAAS) inhibitors to slow progression and reduce the risk of cardiovascular events, given the absence until recently of other treatments clearly proven to improve outcomes for people with CKD. Although combining agents with different mechanisms of action has been routine for people with hypertension, cardiovascular disease, and heart failure, the lack of treatments has limited application in people with CKD to date. However, recent advances in therapy have created the opportunity for combination therapies to slow progression. Here, we provide an overview of recent developments that have changed the standard of care for CKD, with a focus on summarizing available data regarding the effects of combination therapy with newer classes of kidney protective agents. no caption availablePurpose of reviewRecent advances in the treatment of chronic kidney disease (CKD) have led to the development of several new agents that are kidney protective, particularly in people with diabetes. These agents include sodium/glucose cotransporter-2 inhibitors (SGLT-2 inhibitors), mineralocorticoid receptor antagonists (MRAs), and glucagon-like peptide-1 receptor agonists (GLP-1RAs). This review summarizes the available data regarding the effects of using these therapies in combination.There is convincing evidence that SGLT-2 inhibitors and MRAs individually improve kidney function and reduce the risk of cardiovascular events in people with CKD, especially diabetic CKD. There is some evidence that GLP-1RAs may be beneficial, but further studies are needed.The available data support an additive kidney and cardiovascular benefit using combination therapy with SGLT-2 inhibitors and MRAs, and possibly with SGLT2 inhibitors and GLP-1RAs, but more long-term data are needed. The currently available data suggest that combining these agents would likely be beneficial and may be an appropriate long-term strategy.Several new agents are useful in slowing the progress of CKD. Further research to identify which combinations of agents work best together and which combinations are most effective for people with different characteristics, in order to personalize treatment and improve outcomes for people with CKD, should be a priority.Papers of particular interest, published within the annual period of review, have been highlighted as:Chronic kidney disease (CKD) is a slowly progressive disease that affects almost 10% of the world's population [1]. CKD increases the risk of kidney failure, cardiovascular disease, and death. Slowing the progression of kidney disease in the absence of the capacity to halt the progression or 'cure' the disease is crucial. Treatment has traditionally focused on lifestyle changes and the use of renin-angiotensin-aldosterone system (RAAS) inhibitors to slow progression and reduce the risk of cardiovascular events, given the absence until recently of other treatments clearly proven to improve outcomes for people with CKD. Although combining agents with different mechanisms of action has been routine for people with hypertension, cardiovascular disease, and heart failure, the lack of treatments has limited application in people with CKD to date. However, recent advances in therapy have created the opportunity for combination therapies to slow progression. Here, we provide an overview of recent developments that have changed the standard of care for CKD, with a focus on summarizing available data regarding the effects of combination therapy with newer classes of kidney protective agents. no caption availablePurpose of reviewRecent advances in the treatment of chronic kidney disease (CKD) have led to the development of several new agents that are kidney protective, particularly in people with diabetes. These agents include sodium/glucose cotransporter-2 inhibitors (SGLT-2 inhibitors), mineralocorticoid receptor antagonists (MRAs), and glucagon-like peptide-1 receptor agonists (GLP-1RAs). This review summarizes the available data regarding the effects of using these therapies in combination.There is convincing evidence that SGLT-2 inhibitors and MRAs individually improve kidney function and reduce the risk of cardiovascular events in people with CKD, especially diabetic CKD. There is some evidence that GLP-1RAs may be beneficial, but further studies are needed.The available data support an additive kidney and cardiovascular benefit using combination therapy with SGLT-2 inhibitors and MRAs, and possibly with SGLT2 inhibitors and GLP-1RAs, but more long-term data are needed. The currently available data suggest that combining these agents would likely be beneficial and may be an appropriate long-term strategy.Several new agents are useful in slowing the progress of CKD. Further research to identify which combinations of agents work best together and which combinations are most effective for people with different characteristics, in order to personalize treatment and improve outcomes for people with CKD, should be a priority.Papers of particular interest, published within the annual period of review, have been highlighted as:Chronic kidney disease (CKD) is a slowly progressive disease that affects almost 10% of the world's population [1]. CKD increases the risk of kidney failure, cardiovascular disease, and death. Slowing the progression of kidney disease in the absence of the capacity to halt the progression or 'cure' the disease is crucial. Treatment has traditionally focused on lifestyle changes and the use of renin-angiotensin-aldosterone system (RAAS) inhibitors to slow progression and reduce the risk of cardiovascular events, given the absence until recently of other treatments clearly proven to improve outcomes for people with CKD. Although combining agents with different mechanisms of action has been routine for people with hypertension, cardiovascular disease, and heart failure, the lack of treatments has limited application in people with CKD to date. However, recent advances in therapy have created the opportunity for combination therapies to slow progression. Here, we provide an overview of recent developments that have changed the standard of care for CKD, with a focus on summarizing available data regarding the effects of combination therapy with newer classes of kidney protective agents. no caption available