Current and Emerging Nephroprotective Strategies in Chronic Kidney Disease: From RAAS Inhibition to Novel Therapeutics

Abstract

Multidimensional nephroprotection is necessary for chronic kidney disease (CKD) as haemodynamic, metabolic, inflammatory and fibrotic mechanisms play key roles in disease progression. The objective of this study was to assess the use of known and new nephroprotective drugs in adults who had CKD in a cross-sectional, population-based study design. Studies with persons 20 years of age or older were considered. CKD was defined as urine albumin creatinine ratio ≥ 30 mg/g and/or estimated glomerular filtration rate < 60 mL/min/1.73 m². Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors were the categories of prescription drugs. Multivariable logistic regression and survey-weighted descriptive analyses were carried out. Angiotensin receptor blockers (ARBs) or angiotensin-converting enzyme (ACE) inhibitors were used by 43.4% of the 1,003 persons with CKD. Mineralocorticoid receptor antagonists and sodium-glucose cotransporter-2 inhibitors were utilised by just 3.6% and 2.0% of individuals, respectively. The prevalence of use of RAAS inhibitors was 77.2% among persons with diabetes and hypertension. There was a positive association between increasing age, diabetes, and hypertension and increasing use of RAAS inhibitors, with hypertension having the greatest association. In summary, fewer that half of adults with the CKD received this therapy, and generally RAAS inhibition was the most widely used nephroprotective modality. The low adoption of emerging agents shows that there is still a chance to bridge the gap between therapeutic progress and actual deployment.