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Expert Opin Pharmacother. 2019 Feb;20(3):277-294. doi: 10.1080/14656566.2018.1551362. Epub 2018 Dec 3.

Preventing and treating kidney disease in patients with type 2 diabetes.

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a Division of Nephrology, Dialysis and Transplantation, Department of Medicine , Liège , Belgium.
b Division of Clinical Pharmacology, Centre for Interdisciplinary Research on Medicines (CIRM) , University of Liège , Liège , Belgium.
c Department of Medicine, Division of Diabetes , Nutrition and Metabolic Disorders , Liège , Belgium.



Chronic kidney disease (CKD) represents a huge burden in patients with type 2 diabetes (T2DM). This review therefore has the aim of assessing the add-on value of new glucose-lowering agents compared or combined with inhibitors of the renin angiotensin aldosterone system (RAAS) on renal outcomes in T2DM patients.


This article first summarizes the results reported with RAAS inhibitors, mainstay of nephroprotection in T2DM with albuminuria. Second, it describes the positive results with glucagon-like peptide-1 receptor agonists (GLP-1RAs) and, even more impressive, sodium-glucose cotransporter type 2 inhibitors (SGLT2is). Third, besides the potential of combined therapies, it briefly considers some new approaches currently in development.


RAAS inhibitors exert renoprotective effects beyond their blood pressure lowering effects while SGLT2is, and possibly GLP-1RAs, exert nephroprotection independently of their glucose-lowering activity. These effects were demonstrated not only on surrogate endpoints such as albuminuria and estimated glomerular filtration rate decline, but also on hard endpoints, including progression to end-stage renal disease requiring replacement therapy. The underlying mechanisms are different and potentially complementary on glomerular hemodynamics, arguing for combined therapies. Nevertheless, there is still room for new emerging drugs to tackle CKD in T2DM.


Chronic kidney disease; GLP-1 receptor agonist; RAS inhibitors; SGLT2 inhibitor; Type 2 diabetes

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