Diabetes mellitus is the leading cause of chronic kidney disease (CKD) worldwide, and its rising prevalence explains the significant increase in the number of patients receiving renal replacement therapy. Additionally, CKD represents a major cause of morbidity and mortality in patients with diabetes. Hyperglycemia is the cardinal feature that leads to diabetic nephropathy. In fact, elevated glucose levels initiate several inflammatory and metabolic pathways that result in activation of the renin angiotensin aldosterone system (RAAS) and dysregulation of the tubuloglomerular feedback (TGF). For decades, the standard of care to prevent or delay the progression of diabetic kidney disease has included RAAS inhibitors and optimal blood pressure and glycemic control. Fortunately, newer medications have joined the armamentarium of drugs against diabetic nephropathy. Specifically, we will review sodium glucose cotransporter 2 inhibitors (SGLT2is) and the selective mineralocorticoid receptor antagonist (MRA), finerenone, which have proven to decrease the progression of diabetic kidney disease and cardiovascular risk.
Part of the book: Chronic Kidney Disease