Vnitr Lek 2022, 68(7):420-424 | DOI: 10.36290/vnl.2022.089

Current options for slowing the progression of chronic kidney disease

Vladimír Tesař
Klinika nefrologie 1. LF UK a VFN Praha

From a certain stage, chronic kidney disease progresses to terminal kidney failure that requires renal replacement therapy with dialysis or transplantation. The progression can be significantly slowed by blocking the renin angiotensin aldosterone system (RAAS) with angiotensin converting enzyme (ACE) inhibitors or angiotensin II type 1 receptor blockers (ARB). Another new option to enhance the effect of blocking the RAAS system is the use of sodium glucose cotransporter 2 (SGLT2) inhibitors, or gliflozins. Dapagliflozin is currently available and reimbursed for patients with both diabetic and non-diabetic kidney disease. In the near future, treatment with the mineralocorticoid receptor inhibitor finerenone should be made available that significantly potentiates the effect of ACE or ARB inhibitors. Recent data show that it is possible to influence the progression of renal insufficiency with exercise.

Keywords: progression of chronic kidney disease, SGLT2 inhibitor, finerenone, exercise, renin angiotensin system, SGLT2, mineralocorticoid receptor, dapagliflozin.

Accepted: October 17, 2022; Published: October 31, 2022  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Tesař V. Current options for slowing the progression of chronic kidney disease. Vnitr Lek. 2022;68(7):420-424. doi: 10.36290/vnl.2022.089.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Brenner BM, Meyer RW, Hostetter TH. Dietary protein intake and the progressive nature of kidney disease: the role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation, and intrinsic renal disease. N. Engl. J. Med. 1982,307:652-9. Go to original source... Go to PubMed...
    2. Parving HH, Lehnert H, Brochner‑Mortensen J et al. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N. Engl. J. Med.2001,345:870-8. Go to original source... Go to PubMed...
    3. Brenner BM, Cooper ME, de Zeeuw D et al. Effects of losartan on renal outcomes in patients with type 2 diabetes and nephropathy. N. Engl. J. Med. 2001,345:861-9. Go to original source... Go to PubMed...
    4. Lewis EJ, Husicker LG., Clarke WR et al. Renoprotective effect of the angiotensin‑receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N. Engl. J. Med. 2001,345:851-60. Go to original source... Go to PubMed...
    5. Ruggenenti P, Fassi A, Ilieva AP et al. Preventing microalbuminuria in type 2 diabetes. N. Engl. J. Med. 2004,351:1941-51. Go to original source... Go to PubMed...
    6. Maschio G, Alberti D, Janin G et al. Effect of the angiotensin‑converting‑enzyme inhibitor benazepril on the progression of chronic renal insufficiency. The Angiotensi‑Converting‑Enzyme Inhibition in Progressive Renal Insufficiency Study Group. N. Engl. J. Med.1996, 354:939-45. Go to original source... Go to PubMed...
    7. GISEN Group: Randomised placebo‑controlled trial of the effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non‑diabetic nephropathy. Lancet. 1997,349:1857-63. Go to original source...
    8. Fried LF, Emanuele N, Zhang JH et al. Combined angiotensin inhibition for the treatment of diabetic nephropathy. N. Engl. J. Med. 2013,369:1892-1903. Go to original source... Go to PubMed...
    9. Bakris GL, Agarwa lR, Anker SD et al. Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes. N. Engl. J. Med. 2020, October 23, doi: 10.1056/NEJMoa2025845. Go to original source... Go to PubMed...
    10. Ruilope LM, Pitt B, Anker SD et al. Kidney outcomes with finerenone: an analysis from FIGARO‑DKD study. Nephrol. Dial. Tranplant, 2022. doi: 10.1093/ndt/gfac157. Go to original source...
    11. Agarwa lR, Filippatos G, Pitt B et al. Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis. Eur. Heart J. 2022;43:474-484. Go to original source... Go to PubMed...
    12. Perkovic V, Jardine MJ, Nea lB et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N. Engl. J. Med. 2019;380:2295-306. Go to original source... Go to PubMed...
    13. Heerspink HJL, Stefánsson BV, Correa‑Rotter R et al. Dapagliflozin in patients with chronic kidney disease. N. Engl. J. Med. 2020;383:1436-1446. Go to original source... Go to PubMed...
    14. Agarwa lR, Anker SD, Filippatos G et al. Effects of canagliflozin versus finerenone on cardiorenal outcomes: exploratory post hoc analyses from FIDELIO‑DKD compared to reported CREDENCE results. Nephrol. Dial. Transplant. 2022;37:1261-1269.
    15. Rosenstock J, Perkovic V, Johansen OE et al. Effect of linagliptin vs placebo on major cardiovascular events in adults with type 2 diabetes and high cardiovascular and renal risk: The CARMELINA randomized controlled trial. JAMA. 2019;321:69-79. Go to original source... Go to PubMed...
    16. Tuttle KR, Lakshmanan MC, Rayner B et al. Dulaglutide versus insulin glargine in patients with type 2 diabetes and moderate‑to‑severe chronic kidney disease (AWARD-7): a multicentre, open‑label, randomised trial. Lancet Diabetes Endocrinol. 2018;6:605-617. Go to original source... Go to PubMed...
    17. Gerstein HC, Colhoun HM, Dagenais GR et al. Dulaglutide and renal outcomes in type 2 diabetes: an exploratory analysis of the REWIND randomised, placebo‑controlled trial. Lancet. 2019;394:1312-138. Go to original source... Go to PubMed...
    18. Shlipak MG, Sheshadri A, Hsu FC et al. Effect of structured, moderate exercise on kidney function declline in sedentary older adults: an ancillary analysis of the LIFE study randomized clinical trial. JAMA Intern. Med. 2022;182:650-659.

    Return to the content


    Vnitřní lékařství

    Madam, Sir,
    please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
    Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

    I declare:

    1. that I have met the above instruction
    2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited

    No
    Yes

    If your statement is not true, please be aware
    that brings the risk of danger to their health or the health of others.