A Framework for Risk-Based Implementation of Combination Therapy in CKD: Who, Why, When, and How?
Publication Title
Clin J Am Soc Nephrol
Document Type
Article
Publication Date
6-23-2026
Keywords
washington; spokane; pmrc
Abstract
Therapeutic options for chronic kidney disease (CKD) have expanded substantially in recent years, creating new opportunities to reduce residual kidney and cardiovascular risk through combination therapy. Evidence from large, randomized trials and meta-analyses demonstrates that sodium-glucose co-transporter 2 (SGLT2) inhibitors, non-steroidal mineralocorticoid receptor antagonists (MRAs), and glucagon-like peptide-1 (GLP-1) receptor agonists provide independent and additive benefits, with emerging data showing that select combinations may also improve safety. A risk-based approach, anchored in albuminuria and supported by validated risk equations, can guide treatment intensity, support more timely initiation of multidrug regimens, and improve health system efficiency. Addressing implementation barriers, advancing single-pill combinations, and leveraging adaptive and combination therapy trials will be essential to translate these therapeutic advances into improved long-term outcomes for people with CKD.
Area of Special Interest
Kidney & Diabetes
Specialty/Research Institute
Endocrinology
Specialty/Research Institute
Nephrology
DOI
10.2215/CJN.0000001158
