What is the clinical evidence from this study?

Study design: Review. Population: Diabetic kidney disease. Intervention: SGLT2i, GLP-1RA, ns-MRA, and RAAS blockade vs. Single agents.

What question did this study set out to answer?

This research aims to outline recent advancements in the management of diabetic kidney disease (DKD) and propose future directions for therapy.

July 26, 2026Singapore Medical JournalOpen Access

Rapidly changing landscape of diabetic kidney disease management: recent advances and the road ahead

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Key result

Combining SGLT2i, ns-MRA, and RAAS blockade slows diabetic kidney disease progression versus single agents.

Why the study?

Does combination therapy with SGLT2i, GLP-1RA, ns-MRA, and RAAS blockade slow disease progression in patients with diabetic kidney disease?

Population

Patients with diabetic kidney disease (DKD)

Comparison

Combination therapy including sodium-glucose… vs Single agent therapy

Design

Review

Authors

SWSamuel Sherng Young WangSingHealth YCYan Zhi ChanDuke-NUS Medical School XLXiao Ran LuoNational University of Singapore

Discussion

Member takes

Implication

May support combining SGLT2i, GLP-1RA and ns-MRA in DKD; leaves open optimal sequencing and long-term outcomes.

Key Points

This research aims to outline recent advancements in the management of diabetic kidney disease (DKD) and propose future directions for therapy.
Review of recent randomized controlled trials evaluating the efficacy of SGLT2i, GLP-1RA, and ns-MRA in DKD management.
Analysis of the benefits of combining multiple agents for DKD treatment.
Examination of the outcomes from Phase 2 trials of investigational agents.
Combination therapies with SGLT2i, ns-MRA, and RAAS blockade significantly reduce DKD progression compared to single agents (p-value not specified).
Concurrent use of four agents may offer even greater benefits for DKD management (exact metrics not specified).
Investigational agents like endothelin receptor antagonists show promising results in Phase 2 trials for additional treatment options.

Structured PICO

Does combination therapy with SGLT2i, GLP-1RA, ns-MRA, and RAAS blockade slow disease progression in patients with diabetic kidney disease?

Population

Patients with diabetic kidney disease (DKD)

Intervention

Combination therapy including sodium-glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RA), nonsteroidal mineralocorticoid receptor antagonists (ns-MRA), and renin-angiotensin-aldosterone system (RAAS) blockade

Comparator

Single agent therapy

Outcome

Diabetic kidney disease progression and cardiorenal benefits

A comprehensive four-pillar pharmacological approach combining SGLT2i, GLP-1RA, ns-MRA, and RAAS blockade may become the future standard for managing diabetic kidney disease and providing cardiorenal protection.

Cite This Study

Wang et al. (2026) conducted a review in Diabetic kidney disease. SGLT2i, GLP-1RA, ns-MRA, and RAAS blockade vs. Single agents was evaluated. Combining SGLT2i, ns-MRA, and RAAS blockade significantly slows diabetic kidney disease progression compared with using single agents.

synapsesocial.com/papers/6a65a7b4d3aea3239cd78706 https://doi.org/10.4103/singaporemedj.smj-2025-240

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