{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T07:11:36Z","timestamp":1779088296492,"version":"3.51.4"},"reference-count":73,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004191","name":"Novo Nordisk","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004191","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Chronic kidney disease (CKD) is a complex and progressive condition ultimately leading to premature death. Diabetes is the leading cause of end-stage kidney disease worldwide. Up till 2024, international clinical guidelines have established three therapeutic pillars to delay CKD progression in people with type 2 diabetes (T2D): renin-angiotensin system inhibitors, sodium-glucose cotransporter 2 inhibitors, and the non-steroidal mineralocorticoid receptor antagonist finerenone. With the recent results from the Evaluate Renal Function with Semaglutide Once Weekly study, the glucagon-like peptide-l receptor agonist (GLP-1 RA) class is now considered a new therapeutic pillar in reducing CKD complications in this patient population. In this expert opinion, we identify patient populations at risk of developing new onset or worsening pre-existing CKD to explore optimal therapeutic strategies, introducing GLP-1 RAs. We highlight the important challenges that remain in optimising, sequencing, and combining these four therapeutic pillars. Even though the conventional approach of combining the pillars has been based on the historical emergence of evidence, we discuss the factors that would influence physicians\u2019 decision for preferring one pillar over another, and for selecting a certain combination, whether performed simultaneously or sequentially. These factors include the grade of CKD and the level of albuminuria; diabetic control (glycaemia); comorbidities: atherosclerotic cardiovascular disease, heart failure, obesity; concomitant medications; biological variables: potassium serum levels. The efficacy and safety profiles of each pillar, as demonstrated in landmark trials that have clearly shown the nephroprotective effects, along with real-world data, should also be carefully considered when selecting the most appropriate therapeutic option.<\/jats:p>","DOI":"10.1093\/eurjpc\/zwaf426","type":"journal-article","created":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T14:04:10Z","timestamp":1752501850000},"page":"8-18","source":"Crossref","is-referenced-by-count":5,"title":["Expert perspectives on incorporating glucagon-like peptide-1 receptor agonist in diabetes and chronic kidney disease: challenges and opportunities"],"prefix":"10.1093","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0723-7735","authenticated-orcid":false,"given":"Jean-Michel","family":"Halimi","sequence":"first","affiliation":[{"name":"Department of Nephrology-Hypertension, Renal Dialysis and Transplantation, CHRU de Tours , 2 Boulevard Tonnell\u00e9, Tours 37000 ,","place":["France"]},{"name":"INSERM UMR 1327, ISCHEMIA, University of Tours , Tours ,","place":["France"]},{"name":"INI-CRCT , Tours ,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laurent","family":"Fauchier","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centre Hospitalier R\u00e9gional Universitaire de Tours , Tours ,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandre","family":"Karras","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Assistance Publique\u2014H\u00f4pitaux de Paris, Georges Pompidou European Hospital , Paris ,","place":["France"]},{"name":"Department of Medicine, Universit\u00e9 Paris Cit\u00e9 , Paris ,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chlo\u00e9","family":"Amouyal","sequence":"additional","affiliation":[{"name":"Diabetology Department, Institute of Cardiometabolism and Nutrition (ICAN), Piti\u00e9-Salp\u00eatri\u00e8re Hospital, Assistance Publique-H\u00f4pitaux de Paris , Paris 75013 ,","place":["France"]},{"name":"Sorbonne Universit\u00e9, INSERM, Nutriomic Team , Paris ,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominique","family":"Eladari","sequence":"additional","affiliation":[{"name":"M\u00e9decine de Pr\u00e9cision des maladies M\u00e9taboliques et R\u00e9nales, Service de N\u00e9phrologie, CHU Amiens-Picardie, Universit\u00e9 de Picardie Jules Verne , Amiens 80054 ,","place":["France"]},{"name":"Paris Cardiovascular Research Center (PARCC), INSERM U970 , Paris F-75015 ,","place":["France"]},{"name":"FCRIN-INI-CRCT , Vand\u0153uvre-l\u00e8s-Nancy 54500 ,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Rossignol","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) , Nancy ,","place":["France"]},{"name":"Department of Medical Specialties and Nephrology-Hemodialysis, Princess Grace Hospital, and Centre d\u2019H\u00e9modialyse Priv\u00e9 de Monaco, and M-CRIN , Monaco,","place":["Monaco"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriel","family":"Choukroun","sequence":"additional","affiliation":[{"name":"Nephrology Dialysis Transplantation Department, CHU Amiens Picardie and Jules Verne University , Amiens 80000 ,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philippe","family":"Zaoui","sequence":"additional","affiliation":[{"name":"Department of Medicine, Universit\u00e9 Grenoble Alpes , La Tronche 38700 ,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolas","family":"Girerd","sequence":"additional","affiliation":[{"name":"University of Lorraine, Center of Plurithematic Clinical Investigations 1433 and INSERM U1116, CHRU Nancy, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) , Nancy ,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7110-6994","authenticated-orcid":false,"given":"Samy","family":"Hadjadj","sequence":"additional","affiliation":[{"name":"L\u2019Institut du Thorax, Nantes University, CHU Nantes, CNRS, INSERM , Nantes ,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,7,15]]},"reference":[{"key":"2026010607170587900_zwaf426-B1","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1038\/s41581-024-00820-6","article-title":"Chronic kidney disease and the global public health agenda: an international consensus","volume":"20","author":"Francis","year":"2024","journal-title":"Nat Rev 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