In the pursuit of nephroprotection. The pillars of the 2024 treatment

Abstract

Chronic kidney disease has, after almost 20 years of “status quo,” made significant progress in terms of nephroprotection. In the last five years, in addition to the already consolidated renal protection provided by drugs that block the renin-angiotensin system, three other strategies have been added that have confirmed significant benefits for the kidney and its functionality. These are type 2 inhibitors of sodium-glucose co-transport, mineralocorticoid receptor antagonists, particularly non-steroidal ones, and recently GLP-1 receptor agonists. The latter two strategies have solid evidence of kidney disease secondary to type 2 diabetes mellitus for now. This review describes the main results that support their effects and indications for these drugs. These support the growing consensus on their combined use as pillars of nephroprotective treatment. It is possible that with new results and an understanding of how to associate these strategies with each patient or clinical phenotype preferentially, we can obtain increasing benefits to significantly change the course of CKD.