Abstract: TH-PO0381
Combination Treatment for Cardiorenal Protection in US Adults
Session Information
- Diabetic Kidney Disease: From Early Biomarkers to Novel Therapeutic Targets
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 702 Diabetic Kidney Disease: Clinical
Authors
- Nardone, Massimo, University Health Network, Toronto, Ontario, Canada
- Dubrofsky, Lisa, Women's College Hospital, Toronto, Ontario, Canada
- Faruque, Labib, University Health Network, Toronto, Ontario, Canada
- Mohsen, Mai Hatem, University Health Network, Toronto, Ontario, Canada
- Cooper, Matthew, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Olufemi, Modupe F, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Brown, Tyler D., Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Young, Ann, Unity Health Toronto, Toronto, Ontario, Canada
- Auguste, Bourne L., Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Abdel-Qadir, Husam, Women's College Hospital, Toronto, Ontario, Canada
- Wald, Ron, Unity Health Toronto, Toronto, Ontario, Canada
- Persson, Frederik, Kobenhavns Universitet, Copenhagen, Capital Region of Denmark, Denmark
- Wanner, Christoph, University of Oxford, Oxford, England, United Kingdom
- Butler, Javed, Baylor Scott & White Research Institute, Dallas, Texas, United States
- Juni, Peter, University of Oxford, Oxford, England, United Kingdom
- Marx, Nikolaus, Universitatsklinikum Aachen, Aachen, NRW, Germany
- Cherney, David, University Health Network, Toronto, Ontario, Canada
- Odutayo, Ayodele, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Background
Clinical guidelines recommend combined use of renin-angiotensin system inhibitors (RASi), sodium-glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP1RA) and nonsteroidal mineralocorticoid receptor antagonists (nsMRA). Few data exist on eligibility for combined treatment in US adults.
Methods
Using the 2017-2020 National Health and Nutrition Examination Survey (NHANES), we estimated eligibility for combination treatment based on grade 1A to 2B recommendations for CKD or cardiovascular (CV) events in 6 clinical guidelines from KDIGO, AHA/ACC, ADA, and RCTs published after the guidelines (SELECT, FLOW, FINEARTS-HF). For combination treatment, we accounted for acute changes in eGFR, UACR and serum potassium at 3 months with each medication class before determining eligibility for the next medication class in the sequence. We stratified results by diabetes (DM) and CKD. We linked NHANES 2007-2016 to the 2018 Death Index to estimate all-cause and CV deaths in eligible adults. Using direct treatment effects of combination treatment from meta-analyses, we projected the number of prevented deaths.
Results
Of 8152 adults, 15% had DM, 14% CKD and 5% DM and CKD (DKD). Mean age, eGFR, and UACR were 48yrs, 97ml/min/1.73m2, and 31mg/g. The dual-therapy with highest eligibility was RASi-SGLT2i, with 12% of the US population eligible (DM: 67%; CKD: 43%; DKD: 89%). The triple-therapy with highest eligibility was RASi-SGLT2i-GLP1RA, with 9% overall eligibility (DM: 58%; CKD: 26%; DKD: 67%). Eligibility for quadruple-therapy was 2% overall (DM: 15%; CKD:13%; DKD: 32%). Despite an overall 5% lower eligibility for triple therapy with RASi-SGLT2i-GLP1RA vs. dual therapy with RASi-SGLT2i, all-cause and CV deaths were reduced by ≥33% for RASi-SGLT2i-GLP1RA vs. RASi-SGLT2i, due to synergistic benefits.
Conclusion
Eligibility for combined treatment with novel cardiorenal protective therapies is highly prevalent, particularly in DKD.
Funding
- Government Support – Non-U.S.