Nutritional therapy and new drugs in the treatment of MRC

The Maxer Medical Writing team, with the contribution of Annalisa Hinteregger, provided editorial support for the drafting of Integrating the New Pharmacological Standard of Care with Traditional Nutritional Interventions in non-dialysis CKD, an article by Luca De Nicola, Adamasco Cupisti, Claudia D’Alessandro, Loreto Gesualdo, Domenico Santoro, and Vincenzo Bellizzi.

The article, carried out in coordination with AstraZeneca and in collaboration with Aristea, was recently published in the Journal of Nephrology and discusses the authors’ clinical experience in integrating the use of nutritional therapy with sodium-glucose co-transporter inhibitors (SGLT2i) associated with novel potassium ligands, glucagon-like peptide-1 receptor antagonists (GLP1-RA) and nonsteroidal mineralocorticoid receptor antagonists (nsMRA) in the treatment of chronic kidney disease (CKD).

Chronic kidney disease is widely recognized as a major and growing cause of global morbidity and mortality worldwide. Nutritional therapy is the mainstay of metabolic control and may contribute to nephroprotection; however, the lack of robust evidence on slowing the progression of CKD and poor adherence to dietary prescriptions limit its effectiveness and prevent its more widespread use.

SGLT2i are now considered the new standard of care in CKD; in addition, new potassium binders, glucagon-like peptide-1 receptor antagonists (GLP1-RAs), and nonsteroidal mineralocorticoid receptor antagonists (nsMRAs) show direct (SGLT2i, GLP1-RAs, nsMRAs) or indirect (potassium binders that allow optimal use of renin-angiotensin-aldosterone system inhibitors) nephroprotective effects.

According to the authors, these drugs could lead to a more permissive diet, thus allowing the patient to reap the benefits of this approach. In particular, SGLT2i and, to a lesser extent, GLP1-RAs and nsMRAs in patients with diabetic kidney disease may counterbalance the hyperfiltration and higher protein intake often seen in obese patients. On the other hand, potassium binders can facilitate adherence to plant-based diets, which are considered healthy due to their high content of essential micronutrients such as antioxidant vitamins, minerals, alkalis, and fibre.