Key result
nsMRAs and GLP-1 RAs substantially improve kidney and CV outcomes in diabetic CKD.
Why the study?
Patients with chronic kidney disease and diabetes face high risks of cardiovascular disease and heart failure, prompting a review of comprehensive risk mitigation including recent trials of ns-MRAs and GLP-1 RAs.
Nonsteroidal MRAs and GLP-1 RAs demonstrate substantial benefits and favorable safety profiles, supporting their inclusion in comprehensive cardiovascular risk reduction strategies for patients with CKD and diabetes.
May inform CV risk reduction in CKD and diabetes; leaves open need for prospective validation.
PURPOSE OF REVIEW: Patients with chronic kidney disease and diabetes are at high risk of cardiovascular disease, including heart failure. Risk mitigation requires a comprehensive approach with lifestyle modifications, blood pressure management, renin-angiotensin blockade, and sodium-glucose cotransporter 2 inhibitors. Recent trials have shown that nonsteroidal mineralocorticoid receptor antagonists (ns-MRA) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) should also be components of this approach. This review will discuss the comprehensive approach to mitigating risk in these high-risk patients and highlight the recent trials of ns-MRAs and GLP-1 RA. RECENT FINDINGS: In recent years, large, randomized controlled trials of ns-MRA and GLP-1 RA have shown benefit in kidney and cardiovascular outcomes for patients with chronic kidney disease and diabetes. SUMMARY: The substantial benefits and overall favorable safety profiles for ns-MRA and GLP-1 RA in patients with chronic kidney disease and diabetes demonstrate that these medications should be considered as a part of a comprehensive approach to cardiovascular risk reduction in this high-risk population. Future studies should consider different combination therapies and guide how and when to initiate these therapies.
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Kowalczyk et al. (2025) conducted a review in chronic kidney disease and diabetes. nonsteroidal mineralocorticoid receptor antagonists (ns-MRA) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) was evaluated. Nonsteroidal mineralocorticoid receptor antagonists and GLP-1 receptor agonists provide substantial benefits for kidney and cardiovascular outcomes in patients with chronic kidney disease and diabetes.
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