Kidney Week Early 2025 Program - Diabetes Management for the Nephrology Care Team: New Technology and New Drugs-Combination Therapies for Holistic Health in T2D and Kidney Disease

Video Transcription

Video Summary

Dr. Janani Rangaswamy discusses how care for patients with type 2 diabetes and chronic kidney disease (CKD) must move beyond glucose control to reducing the much larger competing risks of cardiovascular events and premature death—often occurring before kidney failure. She highlights rapid advances in “disease-modifying” therapies with multi-organ benefits, including RAS inhibitors, SGLT2 inhibitors, nonsteroidal MRAs (finerenone), and GLP-1 receptor agonists (notably the FLOW trial), emphasizing consistent trial evidence for kidney and cardiovascular protection and, in some cases, mortality reduction.<br /><br />Despite these gains, substantial residual risk remains, especially in patients with persistent albuminuria and declining eGFR even on therapy. This supports a rationale for combination treatment, backed by mechanistic complementarity and emerging data (animal studies, ROTATE, and CONFIDENCE) showing additive albuminuria reduction and potentially mitigated hyperkalemia risk with certain combinations.<br /><br />She argues for personalized, risk-based intensification using updated tools and frameworks (KDIGO guidance, CKM staging, PREVENT-CVD calculator incorporating kidney measures), rather than treating everyone the same. Major challenges include low real-world uptake of even standard therapies, safety uncertainty from shortened trials, underrepresented populations, and barriers such as access, disparities, and cost.<br /><br />In Q&A, she reinforces lifestyle change as foundational but notes implementation requires better behavioral strategies and nonjudgmental, supportive approaches.

Asset Subtitle

Janani Rangaswami

Meta Tag

Module DKD

Speaker Janani Rangaswami

Keywords

type 2 diabetes

chronic kidney disease (CKD)

cardiovascular risk reduction

SGLT2 inhibitors

finerenone (nonsteroidal MRA)

GLP-1 receptor agonists (FLOW trial)

combination therapy and residual risk (albuminuria, eGFR)