Treating diabetic kidney disease early on with multiple medications is essential to ensuring the best outcomes, according to a presentation given at the 2021 Heart in Diabetes conference and reported in a Healio article.
The presentation by Ralph A. DeFronzo, MD, a professor of medicine and chief of the diabetes division at the University of Texas Health Science Center at San Antonio, noted that treating chronic kidney disease in people with diabetes has multiple goals. One such goal, of course, is protecting the kidneys from damage, but a broader treatment strategy that focuses on overall cardiovascular protection is also needed for optimal protection against complications.
Multiple medication strategies recommended
Specifically, the presentation recommended three or even four medication strategies for treating diabetic kidney disease. The first is taking an angiotensin converting enzyme (ACE) inhibitor or an angiotensin receptor blocker, which helps relax the blood vessels to lower blood pressure. Elevated blood pressure is one of the main causes of small blood vessel damage, which can degrade the kidneys’ ability to filter waste products from the blood over time. The filtering units of the kidneys, called nephrons, depend on networks of tiny blood vessels in the organ.
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The second recommended medication strategy is taking an SGTL2 inhibitor, a type of drug that was originally developed to help lower blood glucose in type 2 diabetes. But clinical trials of at least one drug in this class — Farxiga (dapagliflozin) — also found a major benefit when it came to kidney outcomes, and the U.S. Food and Drug Administration (FDA) approved the drug specifically for the treatment of kidney disease earlier this year.
The third recommended strategy is taking the drug Kerendia (finerenone), a drug specifically developed to treat diabetic kidney disease. This fairly new drug, which received its initial FDA approval earlier this year, has been shown to reduce the risk for both kidney and heart complications in people with chronic kidney disease linked to type 2 diabetes.
The fourth and final recommended strategy — at least in some cases — is taking a GLP-1 receptor agonist, a class of injectable drugs designed to lower blood glucose in type 2 diabetes that includes Byetta (exenatide), Ozempic (semaglutide), and Trulicity (dulaglutide). But while these drugs have mostly been shown to improve cardiovascular outcomes, they’ve had mixed results when it comes specifically to kidney outcomes, and it may turn out that certain drugs in this class work better than other for optimal kidney protection.
DeFronzo cautioned that using multiple drugs to reduce the progression of diabetic kidney disease is controversial, since there is no data from large scale clinical trials to support this approach — instead, the evidence for each drug comes from separate clinical trials. But despite this lack of data, he contends that there is an urgent need to aggressively treat diabetic kidney disease early in its course. Unlike certain complications of diabetes, he noted, there has been no progress in reducing the prevalence of diabetic kidney disease — so a bold new strategy may be needed to reduce the burden of chronic kidney disease in people with diabetes.
Want to learn more about keeping your kidneys healthy with diabetes? Read “Managing Diabetic Kidney Disease,” “How to Keep Your Kidneys Healthy,” “Protecting Your Kidneys,” and “Kidney Disease: Your Seven-Step Plan for Prevention.”
