{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:48:06Z","timestamp":1792788486067,"version":"4.5.0"},"reference-count":82,"publisher":"The Endocrine Society","issue":"7","license":[{"start":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T00:00:00Z","timestamp":1776038400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100019718","name":"Boehringer Ingelheim","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100019718","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000191","name":"Kidney Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000191","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Allied Health Kidney Scholarship"},{"DOI":"10.13039\/501100000064","name":"Banting & Best Diabetes Centre","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000064","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003579","name":"University of Toronto","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003579","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Research Excellence, Diversity, and Independence"},{"name":"Early Career Transition Award"},{"DOI":"10.13039\/501100000191","name":"Kidney Foundation of Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000191","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>Renin-angiotensin system inhibitors (RASi), sodium glucose cotransporter-2 inhibitors (SGLT2i), non-steroidal mineralocorticoid receptor antagonists (nsMRA), and glucagon-like peptide-1 receptor agonists (GLP-1RA) are key components of guideline-directed medical treatments (GDMT) for chronic kidney disease (CKD) with type 2 diabetes (T2D). However, the combined use of these medications remains uncommon in clinical practice, in part, due to the absence of specific guidance on implementing combination treatment. Herein, we aim to (1) summarize the evidence supporting combination GDMT in CKD with T2D, (2) propose a practical algorithm to guide the accelerated implementation of quadruple treatment, and (3) discuss strategies to improve the uptake of combination treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Evidence Acquisition<\/jats:title>\n                    <jats:p>We searched PubMed from inception to present for English-speaking studies using the search terms: \u201crenin-angiotensin system inhibitor,\u201d \u201csodium glucose cotransporter-2 inhibitor,\u201d \u201cnonsteroidal mineralocorticoid receptor antagonist,\u201d \u201cglucagon-like peptide-1 receptor agonist,\u201d and \u201cdiabetes.\u201d We focused on clinical guidelines, randomized controlled trials (RCTs), and, if necessary, large observational studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Evidence Synthesis<\/jats:title>\n                    <jats:p>SGLT2i, nsMRA, and GLP-1RA confer early cardiovascular and kidney protection through independent mechanisms, allowing them to be combined. RCTs support the use of each agent on top of \u201cstandard care,\u201d and multiple clinical guidelines endorse combination treatment. However, the optimal order and timing for medication initiation and the approach to managing treatment-related side effects remain uncertain, thereby limiting the uptake of combination treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Current evidence supports the use of combination GDMT in CKD with T2D. We propose a combination treatment algorithm that may combat clinical inertia and achieve greater cardiorenal risk reduction in high-risk patients with CKD and T2D.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/clinem\/dgag163","type":"journal-article","created":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T11:37:36Z","timestamp":1775907456000},"page":"e1726-e1738","source":"Crossref","is-referenced-by-count":4,"title":["Combination treatment for the management of chronic kidney disease and type 2 diabetes: a review and practical guidance"],"prefix":"10.1210","volume":"111","author":[{"given":"Mai","family":"Mohsen","sequence":"first","affiliation":[{"name":"Division of Nephrology, University Health Network , Toronto, ON M5G 2C4 ,","place":["Canada"]},{"name":"Temerty Faculty of Medicine, University of Toronto , Toronto, ON M5S 1A8 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tae 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