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CKD frequently coexists with heart failure and atherosclerotic cardiovascular disease in the broader context of cardio-kidney-metabolic syndrome. Diabetes and CKD are associated with increased risk of all-cause and cardiovascular death as well as decreased quality of life. The role of metabolic and hemodynamic abnormalities has long been recognized as an important contributor to the pathogenesis and progression of CKD in diabetes, while a more recent and growing body of evidence supports activation of both systemic and local inflammation as important contributors. Current guidelines recommend therapies targeting pathomechanisms of CKD in addition to management of traditional risk factors such as hyperglycemia and hypertension. Sodium-glucose cotransporter-2 inhibitors are recommended for treatment of patients with CKD and type 2 diabetes (T2D) if eGFR is \u226520\u00a0ml\/min\/173\u00a0m2 on a background of renin-angiotensin system inhibition. For patients with T2D, CKD, and atherosclerotic cardiovascular disease, a glucagon-like peptide-1 receptor agonist is recommended as additional risk-based therapy. A non-steroidal mineralocorticoid receptor antagonist is also recommended as additional risk-based therapy for persistent albuminuria in patients with T2D already treated with renin-angiotensin system inhibition. Implementation of guideline-directed medical therapies is challenging in the face of rapidly accumulating knowledge, high cost of medications, and lack of infrastructure for optimal healthcare delivery. Furthermore, studies of new therapies have focused on T2D and CKD. Clinical trials are now planned to inform the role of these therapies in people with type 1 diabetes (T1D) and CKD.<\/jats:p>","DOI":"10.1093\/ckj\/sfad285","type":"journal-article","created":{"date-parts":[[2023,11,16]],"date-time":"2023-11-16T23:24:31Z","timestamp":1700177071000},"source":"Crossref","is-referenced-by-count":17,"title":["Optimization of guideline-directed medical therapies in patients with diabetes and chronic kidney disease"],"prefix":"10.1093","volume":"17","author":[{"given":"Joshua J","family":"Neumiller","sequence":"first","affiliation":[{"name":"College of Pharmacy and Pharmaceutical Sciences, Washington State University , Spokane, WA , USA"},{"name":"Providence Medical Research Center , Providence Inland Northwest Health, Spokane, WA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radica Z","family":"Alicic","sequence":"additional","affiliation":[{"name":"Providence Medical Research Center , Providence Inland Northwest Health, Spokane, WA , USA"},{"name":"Department of Medicine, University of Washington , Seattle, WA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine R","family":"Tuttle","sequence":"additional","affiliation":[{"name":"Providence Medical Research Center , Providence Inland Northwest Health, Spokane, WA , USA"},{"name":"Department of Medicine, University of Washington , Seattle, WA , USA"},{"name":"Nephrology Division, Kidney Research Institute, and Institute of Translational Health Sciences, University of Washington , Seattle, WA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,11,16]]},"reference":[{"key":"2024011115211778300_bib1","volume-title":"System USRD; 2022 USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States","author":"National Institutes of Health NIoDaDaKDs.","year":"2022"},{"key":"2024011115211778300_bib2","author":"Centers for Disease Control and Prevention"},{"key":"2024011115211778300_bib3","first-page":"850","article-title":"KDOQI","volume":"60","author":"National Kidney Foundation","year":"2012","journal-title":"Am J Kidney Dis"},{"key":"2024011115211778300_bib4","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1016\/S0140-6736(12)60572-8","article-title":"Risk of coronary events in people with chronic kidney disease compared with those with diabetes: a population-level cohort study","volume":"380","author":"Tonelli","year":"2012","journal-title":"Lancet"},{"key":"2024011115211778300_bib5","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1053\/j.ajkd.2011.09.017","article-title":"Relative incidence of ESRD versus cardiovascular mortality in proteinuric type 2 diabetes and nephropathy: results from the DIAMETRIC (Diabetes Mellitus Treatment for Renal Insufficiency Consortium) database","volume":"59","author":"Packham","year":"2012","journal-title":"Am J Kidney Dis"},{"key":"2024011115211778300_bib6","doi-asserted-by":"crossref","first-page":"2032","DOI":"10.2215\/CJN.11491116","article-title":"Diabetic kidney disease: challenges, progress, and possibilities","volume":"12","author":"Alicic","year":"2017","journal-title":"Clin J Am Soc Nephrol"},{"key":"2024011115211778300_bib7","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1016\/S0140-6736(12)61350-6","article-title":"Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis","volume":"380","author":"Fox","year":"2012","journal-title":"Lancet"},{"key":"2024011115211778300_bib8","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1016\/j.kint.2022.08.012","article-title":"Diabetes management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO)","volume":"102","author":"de Boer","year":"2022","journal-title":"Kidney Int"},{"key":"2024011115211778300_bib9","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.kint.2022.06.008","article-title":"KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease","volume":"102","author":"Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group","year":"2022","journal-title":"Kidney Int"},{"key":"2024011115211778300_bib10","doi-asserted-by":"crossref","first-page":"e1918169","DOI":"10.1001\/jamanetworkopen.2019.18169","article-title":"Clinical characteristics of and risk factors for chronic kidney disease among adults and children: an analysis of the CURE-CKD registry","volume":"2","author":"Tuttle","year":"2019","journal-title":"JAMA Netw Open"},{"key":"2024011115211778300_bib11","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1186\/s12902-022-01026-2","article-title":"Global use of SGLT2 inhibitors and GLP-1 receptor agonists in type 2 diabetes. 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