June 24, 2026Clinical Journal of the American Society of Nephrology0 citations
View Full PaperA Framework for Risk-Based Implementation of Combination Therapy in CKD
Key Result
Combination therapy with SGLT2 inhibitors, MRAs, and GLP-1 receptor agonists provides independent and additive benefits to reduce residual kidney and cardiovascular risk in chronic kidney disease.
Key Points
- This research aims to develop a framework for implementing combination therapy in chronic kidney disease (CKD) based on risk assessment.
- Evaluation of evidence from randomized trials and meta-analyses on therapeutic combinations for CKD.
- Development of a risk-based approach using albuminuria and validated risk equations.
- Strategies for overcoming implementation barriers and advancing multidrug regimens.
- Randomized trials show that SGLT2 inhibitors, MRAs, and GLP-1 receptor agonists provide independent benefits for CKD.
- Emerging data indicates that certain drug combinations can enhance safety and efficacy.
- A risk-based framework can facilitate timely treatment initiation and improve health system efficiency.
Structured PICO
P
Population
People with chronic kidney disease (CKD)
I
Intervention
Combination therapy with sodium-glucose co-transporter 2 (SGLT2) inhibitors, non-steroidal mineralocorticoid receptor antagonists (MRAs), and glucagon-like peptide-1 (GLP-1) receptor agonists
A risk-based framework anchored in albuminuria is proposed to guide the implementation of combination therapies (SGLT2 inhibitors, non-steroidal MRAs, GLP-1 receptor agonists) to reduce cardiovascular and kidney risk in CKD.
Abstract
Therapeutic options for chronic kidney disease (CKD) have expanded substantially in recent years, creating new opportunities to reduce residual kidney and cardiovascular risk through combination therapy. Evidence from large, randomized trials and meta-analyses demonstrates that sodium-glucose co-transporter 2 (SGLT2) inhibitors, non-steroidal mineralocorticoid receptor antagonists (MRAs), and glucagon-like peptide-1 (GLP-1) receptor agonists provide independent and additive benefits, with emerging data showing that select combinations may also improve safety. A risk-based approach, anchored in albuminuria and supported by validated risk equations, can guide treatment intensity, support more timely initiation of multidrug regimens, and improve health system efficiency. Addressing implementation barriers, advancing single-pill combinations, and leveraging adaptive and combination therapy trials will be essential to translate these therapeutic advances into improved long-term outcomes for people with CKD.
Cite This Study
Yeung et al. (Tue,) conducted a review in Chronic kidney disease (CKD). Combination therapy (SGLT2 inhibitors, MRAs, GLP-1 receptor agonists) was evaluated. Combination therapy with SGLT2 inhibitors, MRAs, and GLP-1 receptor agonists provides independent and additive benefits to reduce residual kidney and cardiovascular risk in chronic kidney disease.