Diabetic Kidney Disease: The Four Pillars of Therapy
Diabetic kidney disease (DKD) is a serious threat to public health in South Africa and globally, as a major cause of end-stage kidney disease, rising healthcare costs and premature mortality. The advent of several highly efficacious therapies over the last decade has dramatically altered the landscape of DKD management. In addition to lifestyle modification, the management of DKD secondary to type 2 diabetes now centres on four ‘pillars’ of treatment: renin-angiotensin system blockade (with ACE inhibitors or angiotensin receptor blockers), sodium-glucose cotransporter-2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists (though not yet available in South Africa) and glucagon-like peptide-1 receptor agonists. Early implementation of these therapies is likely to confer substantial long term gains in survival, free from cardiovascular and kidney disease.
Modern Medicine – Issue 3, 2025
