This 2025 review highlights the manner in which combination therapy has become the preferred treatment for chronic kidney disease (CKD) in diabetic and non-diabetic patients. CKD treatments have recently come up with new drugs that not only protect the kidneys but also lower the risk of cardiovascular complications and kidney failure. Some of these include drugs like SGLT2 inhibitors, GLP-1 receptor agonists, mineralocorticoid receptor antagonists (such as finerenone), and traditional renin-angiotensin system blockers. They all work in different ways to help patients through mechanisms such as lowering inflammation, regulation of scarring in the kidneys, and improved blood pressure regulation.
Combination therapy is very effective since these drugs complement each other. For example, clinical trials in diabetic CKD have established that the use of more than one drug is better without overlapping side effects. SGLT2 inhibitors, for example, reverse side effects such as fluid retention or potassium accumulation caused by other drugs. Although these drugs were initially investigated in diabetes, their application is now being increasingly recognized in non-diabetic CKD as well. Indeed, targeted therapy for certain kidney diseases such as IgA nephropathy is being actively investigated with encouraging results.
The authors point out that CKD is a multifaceted disease that usually needs a multi-drug treatment protocol to reduce the risk of kidney failure and related medical complications over the lifetime of a patient. They discuss how to individualize treatments to a patient’s risk profile, as well as how to overcome obstacles such as the cost of new therapies and the complexity of co-managing numerous drugs. Determining the optimal timing and order of these treatments is a top priority for future research. The article concludes that combination therapy is a significant step forward in CKD management. With evidence of its efficacy, it provides a means of enhancing survival and quality of life in CKD patients. The strategy, however, needs to be carefully planned to address patient needs to reap its full potential.
Source: academic.oup.com/ndt/article/40/Supplement_1/i59/8002192
