Estimated Glomerular Filtration Rate Slope, Chronic Kidney Disease Progression, and Pillars of Care in Patients With Diabetic Kidney Disease

Chronic kidney disease (CKD) is a progressive condition that affects 800 million people worldwide and remains underdiagnosed, especially in its early stages. Diabetes and hypertension are leading drivers of CKD, largely through hyperglycemia- and pressure-mediated kidney damage. The estimated glomerular filtration rate (eGFR) is a standard measure of kidney function, and clinicians increasingly track its decline (the eGFR slope) to catch early warning signs and guide treatment decisions. Key clinical trials, including CREDENCE, DAPA-CKD, EMPA-KIDNEY, FIDELIO-DKD, FIGARO-DKD, and FLOW, have demonstrated how newer classes of medications can help when added to baseline therapy with renin-angiotensin system blockers. These therapies include sodium–glucose cotransporter 2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists (finerenone), and glucagon-like peptide 1 receptor agonists. By targeting inflammation, hyperfiltration, oxidative stress, and metabolic imbalances, these medications significantly slow eGFR decline and reduce the risk of complications, such as cardiovascular events. Lifestyle interventions, including blood pressure, glycemic, and lipid control, and regular monitoring of eGFR and urinary albumin-to-creatinine ratio are essential components of care. Mounting evidence supports a multitargeted approach, where combination therapy addresses the diverse pathways involved in CKD progression. Regular eGFR and albuminuria assessments are critical for identifying patients at higher risk and monitoring their response to interventions.