Game-Changing Medications for Kidney Disease and Type 2 Diabetes

Before the existence of three new medications designed to help individuals with type 2 diabetes and kidney disease or early-stage kidney disease, we only had ACE inhibitors and angiotensin II receptor blockers that were kidney protective and managed blood pressure. Now we have SGLT2 inhibitors and Finerenone which are also kidney protective.

"The SGLT-2 inhibitors or Flozins that have been shown in randomized clinical trials to reduce the risk of kidney failure by about 30 to 40%," said Dr. Vassalotti, NKF's Chief Medical Officer. "They also reduce the risk of heart failure hospitalization and death, so, these are really powerful medications and a new tool to treat people living with kidney disease to prevent kidney failure and reduce complications."

If you have type 2 diabetes and kidney disease or early-stage kidney disease, you need to know about these medications. Read on to discover what each does and how to ask your doctor if they are right for you. These medications are most kidney protective for those with increased levels of albumin, a type of protein in the urine. 

SGLT2-Inhibitors (Flozins)

SGLT2 inhibitors are FDA-approved to help lower blood sugar in adults with type 2 diabetes and people with kidney disease with an eGFR as low as 20 (CKD stage 4). They may also protect the kidney function of people with early kidney disease who do not have diabetes but have albumin, a type of protein, in the urine.

SGLT2 inhibitors work in a number of ways, but one way is by preventing the kidneys from reabsorbing sugar. As a result, glucose goes into urine. Glucose in the urine used to be a test of poor diabetes control, but is expected with SGLT-2 inhibitors. 

SGLT2 inhibitors are effective for patients with albumin in the urine with or without type-2 diabetes:

• Slowing the progression of kidney disease
• Reducing heart failure hospitalization
• Lowering the risk of kidney failure 
• Reducing the risk of death

Medicines in the SGLT2 inhibitor class:

• Invokana® (canagliflozin)
• Farxiga® (dapagliflozin)
• Jardiance® (empagliflozin)
• Steglatro® (ertugliflozin)

Learn more about SGLT2-Inhibitors.

Finerenone (Non-steroidal mineralocorticoid antagonist (MRA))

Finerenone is FDA-approved¹ for those with type 2 diabetes-associated kidney disease who have an eGFR above 25 and a urine-albumin creatinine ratio above 30. It may improve kidney and heart outcomes by preventing fibrosis or scarring of the kidneys.

According to the FDA, Finerenone is effective at reducing the risk of:

• Kidney function decline
• Kidney failure
• Hospitalization for heart failure

Medicines in the Finerenone class:

• Kerendia®

Learn more about the kidney-heart connection.

GLP-1 RA (Glucagon-like peptide-1 receptor agonists)

GLP-1 RAs are FDA-approved for those with type 2 diabetes to help produce insulin and lower glucose when taken with meals alongside proper diet and exercise. These may also work for those on dialysis. This class of medications is especially recommended for people with kidney disease and coronary artery disease, including heart attack, coronary stents, or bypass surgery.

GLP-1 RA medications are effective at lowering²:

• A1C levels
• Blood pressure
• Risk of cardiovascular events
• Blood sugar
• Albuminuria

Medications in the GLP-1 RA class:

• Trulicity® (Dulaglutide)
• BYDUREON BCise® (Exenatide extended-release)
• Byetta® (Exenatide)
• Ozempic® (Semaglutide injection)
• Victoza® (Liraglutide)
• Saxenda® (Liraglutide)
• Rybelsus® (Semaglutide oral)
• Mounjaro™ (tirzepatide)

Keep reading about the connection between kidney disease and diabetes.

Ask your doctor if these medications are right for you

If you have diabetes and kidney disease or early-stage kidney disease without diabetes, ask your doctor if you could benefit from any of these medications. 

Here’s what to ask:

1. If you have CKD with or without type 2 diabetes, ask if SGLT2 inhibitors are right for me.
2. If you have CKD with type-2 diabetes, also ask if Finerenone, or GLP-1 receptor agonists, are right for me.
3. What are the benefits of these medications?
4. Are there any side effects and how do I manage those?
5. What is the cost of these medications and is any financial assistance available to help with the cost?
6. How would I incorporate this new medication into my existing treatment routine?

NKF Cares is here to help answer your questions about these game-changing medications. Call toll-free at 855.NKF.CARES (855.653.2273) or email nkfcares@kidney.org for support from a trained professional.

Financial assistance

Kidney disease medications and treatments can be very expensive but help is available.

• Discount Card: Use this card for discounts and speak with your healthcare team for help creating a plan to afford your medication. 
• Prescription Resources: Many drug companies offer prescription assistance programs for their medications to those who qualify. 
• Insurance Resources: If you are struggling to afford your medication, you can apply for Social Security or participate in co-pay assistance programs. 

Get more financial resources and learn how to overcome financial hardships with kidney disease.

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Works Cited

¹Center for Drug Evaluation and Research. (n.d.). FDA approves drug for chronic kidney disease. U.S. Food and Drug Administration. Retrieved February 8, 2023, from https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-drug-reduce-risk-serious-kidney-and-heart-complications-adults-chronic-kidney-disease 

²Marx, N., Husain, M., Lehrke, M., Verma, S., & Sattar, N. (2022). GLP-1 receptor agonists for the reduction of atherosclerotic cardiovascular risk in patients with type 2 diabetes. Circulation, 146(24), 1882–1894. https://doi.org/10.1161/circulationaha.122.059595