{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T14:47:50Z","timestamp":1787496470651,"version":"build-2736575974"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T00:00:00Z","timestamp":1768348800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Research Fund for Bajian Talents of Guangdong Provincial Hospital of Chinese Medicine","award":["BJ2022KY11"],"award-info":[{"award-number":["BJ2022KY11"]}]},{"name":"Science and Technology Research Fund","award":["YN2024MB018"],"award-info":[{"award-number":["YN2024MB018"]}]},{"name":"Science and Technology Research Fund","award":["YN2024MS012"],"award-info":[{"award-number":["YN2024MS012"]}]},{"name":"Science and Technology Research Fund","award":["YN2020QN18"],"award-info":[{"award-number":["YN2020QN18"]}]},{"name":"Science and Technology Research Fund","award":["YN2020QN24"],"award-info":[{"award-number":["YN2020QN24"]}]},{"DOI":"10.13039\/501100004047","name":"Karolinska Institutet","doi-asserted-by":"publisher","award":["2020-01616"],"award-info":[{"award-number":["2020-01616"]}],"id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004047","name":"Karolinska Institutet","doi-asserted-by":"publisher","award":["2022-02044"],"award-info":[{"award-number":["2022-02044"]}],"id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Noncommunicable Chronic Diseases-National Science and Technology Major Project","award":["2023ZD0505600"],"award-info":[{"award-number":["2023ZD0505600"]}]},{"name":"Noncommunicable Chronic Diseases-National Science and Technology Major Project","award":["2023ZD0505604"],"award-info":[{"award-number":["2023ZD0505604"]}]},{"DOI":"10.13039\/501100012151","name":"Sanming Project of Medicine in Shenzhen","doi-asserted-by":"publisher","award":["SZZYSM202206014"],"award-info":[{"award-number":["SZZYSM202206014"]}],"id":[{"id":"10.13039\/501100012151","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Guangzhou Basic and Applied Basic Research Foundation","award":["2023A03J0235"],"award-info":[{"award-number":["2023A03J0235"]}]},{"name":"State Key Laboratory of Traditional Chinese Medicine Syndrome Projects","award":["SKLKY2025B0008"],"award-info":[{"award-number":["SKLKY2025B0008"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,30]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Chronic kidney disease (CKD) management has evolved from supportive care with renin\u2013angiotensin system inhibitors (RASi) alone to multi-target combination therapies. While RASi remain foundational, their limited efficacy in fully preventing disease progression (e.g. residual albuminuria) and safety concerns, such as hyperkalemia, have underscored the need for novel therapeutic agents. Sodium-glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RA) and nonsteroidal mineralocorticoid receptor antagonists (nsMRA) demonstrate complementary nephroprotective effects by targeting metabolic, hemodynamic and inflammatory pathways within the cardiovascular\u2013kidney\u2013metabolic (CKM) syndrome framework. Evidence from large-scale studies demonstrates that combination four-pillar therapies are superior to monotherapy in reducing the risk of kidney failure in patients with diabetes and also exhibit complementary safety profiles that enhance tolerability and long-term patient adherence. For example, combining SGLT2i with RASi mitigates hyperkalemia risk and reduces RASi discontinuation, thereby enhancing treatment persistence. The KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of CKD emphasizes patient-centered, team-based management integrating these therapies. Future directions include expanding evidence for non-diabetic CKD populations, more rapid implementation of these four-pillar therapies and new therapies such as aldosterone synthase inhibitors in this vulnerable group.<\/jats:p>","DOI":"10.1093\/ndt\/gfag003","type":"journal-article","created":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T12:27:08Z","timestamp":1768307228000},"page":"1180-1183","source":"Crossref","is-referenced-by-count":1,"title":["Trends in nephrology: from \u201csupportive care\u201d to CKD combination therapy"],"prefix":"10.1093","volume":"41","author":[{"given":"Kaiyu","family":"He","sequence":"first","affiliation":[{"name":"State Key Laboratory of Traditional Chinese Medicine Syndrome, Chinese Medicine Guangdong Laboratory, Guangdong Provincial Key Laboratory of Chinese Medicine for Prevention and Treatment of Refractory Chronic Diseases, Big Data Research Center of Chinese Medicine , Department of Nephrology, The Second Affiliated Hospital, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanrong","family":"Guo","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Traditional Chinese Medicine Syndrome, Chinese Medicine Guangdong Laboratory, Guangdong Provincial Key Laboratory of Chinese Medicine for Prevention and Treatment of Refractory Chronic Diseases, Big Data Research Center of Chinese Medicine , Department of Nephrology, The Second Affiliated Hospital, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7153-9159","authenticated-orcid":false,"given":"Changyuan","family":"Yang","sequence":"additional","affiliation":[{"name":"University Medical 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Affiliated Hospital, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou ,","place":["China"]},{"name":"University of Oxford Nuffield Department of Population Health, , Oxford ,","place":["UK"]},{"name":"Karolinska Institutet Department of Medical Epidemiology and Biostatistics, , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,1,14]]},"reference":[{"key":"2026062922470963400_bib1","doi-asserted-by":"publisher","first-page":"i3","DOI":"10.1093\/ndt\/gfae212","article-title":"Combination therapy: an upcoming paradigm to improve kidney and cardiovascular outcomes in chronic kidney disease","volume":"40","author":"Alicic","year":"2025","journal-title":"Nephrol Dial Transplant"},{"key":"2026062922470963400_bib2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfaf250","article-title":"Trends in nephrology: 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