New and existing cardiorenal therapies can reduce cardiovascular risk in patients with chronic kidney disease (CKD) and diabetes, beyond results achieved from blood pressure, dyslipidemia or glycemic control alone, according to a recent JACC Review Topic of the Week.

Patients with CKD and diabetes have a clear additive risk of cardiovascular events, heart failure and cardiovascular mortality. Despite management with lifestyle interventions like healthy diet, exercise, weight management and smoking cessation, and traditional pharmacotherapy – focused on controlling hyperglycemia, hypertension and dyslipidemia – high residual cardiovascular risk persists in this patient population. “The complex pathophysiology of CKD in diabetes, together with its CV complications, provides many potential mechanistic targets for therapy,” write Javier Morales, MD, and Yehuda Handelsman, MD.

The authors discuss a range of novel medications, including RAAS inhibitors, SGLT2 inhibitors, GLP1-RAs, and nonsteroidal mineralocorticoid receptor antagonists (MRAs), as potential treatments. Although there is limited research to date, they suggest that therapies using a combination of ACE inhibitors or ARBs, SGLT2 inhibitors, nonsteroidal MRAs and possibly GLP1-RAs may further improve kidney and cardiovascular outcomes in this patient group.

They also summarize current evidence-based guidelines, which increasingly encourage combination therapy for patients with CKD and diabetes, including the 2022 American Heart Association/ACC/Heart Failure Society of America Guideline for the Management of Heart Failure as well as recommendations from the Kidney Disease: Improving Global Outcomes Diabetes Work Group, the American Diabetes Association and the European Association for the Study of Diabetes.

Calling for “efforts to introduce clinicians to the contemporary data and medical-directed guideline therapy,” Morales and Handelsman state that clinicians should incorporate these strategies “in the management of patients with diabetes and CKD to improve patient quality of life and reduce morbidity and mortality.”

Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Heart Failure and Cardiomyopathies, Lipid Metabolism

Keywords: Morbidity, Life Style, Dyslipidemias, Hyperglycemia, Heart Disease Risk Factors, Diabetes Mellitus, Kidney, Renal Insufficiency, Chronic, Risk Factors, Renin-Angiotensin System, Cardiovascular Diseases, Quality of Life, Sodium-Glucose Transporter 2, Mineralocorticoid Receptor Antagonists, Angiotensin Receptor Antagonists, Angiotensin-Converting Enzyme Inhibitors, Sodium-Glucose Transporter 2 Inhibitors

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