Can we slow down the decline in renal function?

Abstract

The 'chronic kidney disease' (CKD) definition that best outlines the complex syndrome commonly called 'kidney failure' has become a problem of World Public Health due to its incidence and prevalence and due to exponentially increasing costs in every part of the world. The progressive reduction in the glomerular filtration rate, as known, goes hand in hand with an increase in cardiovascular risk understood as fatal and non-fatal heart attack, stroke, heart failure, and mortality. Therefore, every effort must aim at preventing or slowing down the decline in renal function in order to reduce not only critical renal events (the need for dialysis or transplantation among the most dreadful) but also the incidence of cardiovascular events. Since the disease is asymptomatic for a long time (often its detection is occasional and done with guilty delay), it is clearly important to make a correct and early evaluation of renal function with appropriate methods. Furthermore, it is crucial to make an aetiological diagnosis, when it is possible, of CKD because this will allow for the most targeted therapy possible. For a long time, an effective approach for the majority of people with CKD could only count on strict control of the diabetic disease and its complications, optimization of high blood pressure values, and the mandatory use of drugs blocking the renin-angiotensin-aldosterone system, particularly in the presence of albuminuria. Over time, this strategy proved to be only partially effective and the majority of patients nonetheless showed a progressive worsening of renal function. Only recently have we had access to two classes of innovative drugs such as glyphozines and incretins which have established themselves on the therapeutic scene because they have shown to be able to slow down the progression of CKD, first in patients with type 2 diabetes and subsequently in patients with CKD whether or not they have diabetes. Unexpectedly and convincingly, they have also been shown to significantly impact cardiovascular prognosis. From initially antidiabetic drugs, their effectiveness has forced the medical iconography to enrich itself with a new therapeutic niche by rightly speaking of 'cardio-nephro-metabolic' drugs.