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Kidney Week

Abstract: PO2349

A Systematic Literature Review of Treatment Patterns, Safety Profiles, and Long-Term Disease Progression in Patients with CKD and Type 2 Diabetes Mellitus

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention


  • Singh, Rakesh, Bayer US LLC, Whippany, New Jersey, United States
  • Wissinger, Erika, Xcenda LLC, Carrollton, Texas, United States
  • Dobie, Casey, Xcenda LLC, Carrollton, Texas, United States
  • Du, Yuxian, Bayer US LLC, Whippany, New Jersey, United States

CKD affects ~40% of patients with diabetes. Current guidelines recommend optimization of blood pressure and glycemic control in patients with T2D to reduce the risk of CKD progression. Despite this, patients with T2D are still advancing to ESRD. Real-world treatment patterns, safety profiles of current treatments, and residual risk for long-term disease progression in patients with CKD and T2D were explored.


A systematic literature review was conducted of real-world observational studies in the US in patients with CKD and T2D. Articles published in the past 10 years were identified from Embase and MEDLINE and were evaluated by 2 independent reviewers.


A total of 17 studies were included in the review. In the 16 studies that examined treatment patterns among patients with CKD and T2D, all drug classes of interest (steroidal mineralocorticoid receptor antagonist [MRA], ACEI, ARB, GLP-1RA, and SGLT-2i) were reported. The proportions of patients treated with ACEIs (34%–70%) or ARBs (12%–66%) varied widely, with approximately 45% to 95% of patients prescribed either an ACEI or an ARB. Small proportions of patients (<10%) were treated with MRAs, GLP-1RAs, and SGLT-2is; though steroidal MRA does not have an indication in CKD in T2D. In the 4 studies that examined renal function decline while on a treatment of interest, 1-year progression rates ranged from 3.3% to 29.9%. Three studies reported rates of on-treatment ESRD progression, which ranged from 9.1% to 10%. In the 4 studies reporting AEs in patients treated with MRAs, ACEIs, and/or ARBs, notable clinical events included stroke (12.6% among MRA non-users to 31.3% among spironolactone users) and hyperkalemia (9.1% among MRA non-users to 29.9% among spironolactone users).


The identified studies suggest that patients with CKD and T2D may not be optimized on current treatment options to slow renal function decline and reduce the risk of CV events in these patients. Despite current treatment options, a residual risk of CKD progression and CV morbidity remains. New therapies are needed to slow long-term disease progression.


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