Combination Therapy for Chronic Kidney Disease and Type 2 Diabetes — A Promising Prelude

Zoccali, Carmine F.A.S.N., F.E.R.A.
Mallamaci, Francesca F.E.R.A.

¹Associazione Nefrologia, Dialisi e Trapianto Renale, Grande Ospedale Metropolitano, Reggio Calabria, Italy
²Renal Research Institute, New York
³Institute of Biology and Molecular Genetics, Ariano Irpino, Italy

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New England Journal of Medicine 393(6):p 601-602, August 7, 2025. | DOI: 10.1056/NEJMe2508784

The rising tide of chronic kidney disease among patients with type 2 diabetes continues to challenge clinicians and health systems worldwide.¹ Advances have been made in the management of chronic kidney disease with type 2 diabetes, such as with the approved use of renin-angiotensin system inhibitors, sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and nonsteroidal mineralocorticoid receptor antagonists. Although the use of each of these agents has individually improved outcomes, the most effective combination and sequence of these therapies remain uncertain.² In this context, Agarwal et al.³ conducted the CONFIDENCE trial, a timely and rigorous investigation into the …