Modern Management of Chronic Kidney Disease in T2MD: A Practical Overview for Primary Care Providers

Abstract

The development of chronic kidney disease (CKD) in patients with T2DM (CKD in T2DM) is a common and major comorbidity. Not only is it associated with progressive kidney disease and end-stage kidney disease (ESKD), it is also associated with very high risk for major adverse cardiovascular events (MACE) and heart failure (HF) events. CKD in T2DM is extremely  costly from a health economic perspective; however, most importantly, it results in significant reductions in patient quality of life and survival. For several decades, there has been a lack of new therapeutic options to address residual cardiorenal risk. The traditional pillars of therapy include glycemic control with a HbA1C target of 6.5%, blood pressure control with a blood pressure target of less than 130 mmHg, and the use of renin angiotensin aldosterone inhibitors (RAASi). Recently, several options have emerged that can address residual kidney and cardiovascular risk in these patients, thereby providing organ protection. Importantly, these therapies are grounded in the foundation of solid randomized, controlled clinical trials and are now prevalent in the guidelines that inform the management of CKD in T2DM. The novel pillars for kidney and cardiovascular protection include sodium glucose luminal transported 2 inhibitors (SGLT2i) and finerenone, a non-steroidal mineralocorticoid receptor antagonist (nsMRA). This article highlights practical considerations of these pillars for primary care providers with a focus on kidney protection.