Abstract: PUB039
Four-Pillars, One Goal: A Real-World Case Series of Therapy in Diabetic Kidney Disease
Session Information
Category: Cardiovascular-Kidney-Metabolic Health
- 602 Cardiovascular-Kidney-Metabolic Health: Clinical
Authors
- Zoha, Wardah, Franciscan Health Olympia Fields, Olympia Fields, Illinois, United States
- Mahboob, Amna, Franciscan Health Olympia Fields, Olympia Fields, Illinois, United States
- Olson, Rachael, Midwestern University - Downers Grove Campus, Downers Grove, Illinois, United States
- Sarguroh, Tauseef A., Franciscan Health Olympia Fields, Olympia Fields, Illinois, United States
Introduction
Diabetic kidney disease (DKD) is the leading cause of end stage renal disease in North America. Although randomized trials now support four foundational therapies for DKD, ACEi/ARB, SGLT2 inhibitors, GLP-1 receptor agonists, and non-steroidal MRAs, real-world adoption of all four agents remains limited. Data describing outcomes in outpatient nephrology practice are especially scarce.
Case Description
This descriptive case series included seven adults with T2DM, advanced CKD and proteinuria treated with the full four-pillar regimen. Baseline urine protein to creatinine ratio (UPCR) ranged from 1.4–15.8 g/g and baseline creatinine from 1.95–4.0 mg/dL. Patients were followed for 6–36 months with serial measurements of creatinine, potassium, and UPCR. All patients were on standard of care ACEi/ARB after which medication initiation included SGLT2 inhibitor, GLP-1 RA, and ns-MRA. Primary outcomes were proteinuria change and progression to dialysis. Secondary outcomes included renal function trajectory and potassium safety.
Discussion
All seven patients demonstrated clinically meaningful reductions in proteinuria (14%–89%). The improvements were: UPCR 3.78→0.87 g/g (−77%), 1.40→1.20 g/g (−14%), 1.95→0.96 g/g (−51%), 14.60→12.00 g/g (−18%), 15.80→12.70 g/g (−20%), 3.60→0.40 g/g (−89%), 8.04→2.89 g/g (−64%). Renal function in all seven patients either stabilized or only marginally declined with expected fluctuation in serum creatinine after initiation of each therapy. Potassium elevations were mild and intermittent, with no therapy discontinuations. Importantly, none of the seven patients required initiation of renal replacement therapy during multi-year follow-up.
In real-world outpatient nephrology practice, comprehensive four-pillar therapy was feasible, well tolerated, and associated with substantial reductions in proteinuria, stabilization of renal function, and zero progression to dialysis. These findings support broader implementation of four-pillar therapy to slow DKD progression in routine clinical care.
| Baseline UPCR (g/g) | Follow-up UPCR (g/g) | Net eGFR Trend | % Reduction in Proteinuria | Renal Function Trend | Safety | |
| Patient 1 | 3.78 | 0.87 | ↑ | -77% | Stable | Mild intermittent K↑ |
| Patient 2 | 1.4 | 1.2 | ↔ | -14% | Stable | No significant issues |
| Patient 3 | 1.95 | 0.96 | ↑ | -51% | Stable | Mild intermittent K↑ |
| Patient 4 | 14.6 | 12 | ↔ | -18% | Slight expected creatinine fluctuation | No significant issues |
| Patient 5 | 15.8 | 12.7 | ↔ | -20% | Stable | Mild intermittent K↑ |
| Patient 6 | 3.6 | 0.4 | ↑ | -89% | Stable | No significant issues |
| Patient 7 | 8.04 | 2.89 | ↑ | -64% | Stable | Mild intermittent K↑ |