Which treatments should be prioritized to protect the kidneys of diabetic and overweight people suffering from chronic kidney disease?
Chronic kidney diseases affect one in ten people worldwide and could become the fifth leading cause of premature death by 2040. In adults with type 2 diabetes and obesity, this disease is particularly common and worsens the risk of cardiac complications and severe kidney failure. Two types of medications, often used to manage diabetes, also show benefits for the kidneys: those that help eliminate sugar through urine and those that act like the natural hormone regulating blood sugar and appetite.
A thorough analysis of available research reveals that medications promoting sugar elimination through urine offer more pronounced kidney protection than those mimicking the regulatory hormone. Several large studies have confirmed their effectiveness in slowing kidney degradation, even in patients whose kidney function is already impaired. Their rapid action and independence from weight make them particularly useful in managing diabetes-related kidney failure.
On the other hand, treatments mimicking the regulatory hormone, although long used to control blood sugar and reduce weight, have shown more limited kidney effects. Only one recent study specifically evaluated their impact on the kidneys, showing improvement in diabetic patients with advanced kidney disease. However, this protection appears less extensive than that offered by the first medications and takes longer to manifest.
The mechanisms of action of these two drug families differ. The former reduce pressure in the kidney’s small filters, thus limiting their wear. The latter act mainly by reducing inflammation and oxidative stress, but their effect on kidney function remains less well understood. Their main advantage lies in their ability to improve diabetes control and promote weight loss, which can indirectly benefit the kidneys.
International recommendations advise prioritizing medications that eliminate sugar through urine to protect the kidneys of diabetic and overweight individuals. Treatments mimicking the regulatory hormone are considered more as a complement, especially for patients needing better blood sugar control or a reduction in cardiac risk. Combining both types of medications could provide additional benefits, but more data is needed to specify the order in which to introduce or combine them.
The side effects of both drug classes are generally comparable. Digestive issues, common at the start of hormone-mimicking treatment, tend to decrease over time. Medications that eliminate sugar through urine can lead to urinary or genital infections, but these risks remain manageable.
While scientific evidence leans in favor of the former for kidney protection, each patient must be evaluated individually. The choice of treatment will depend on the state of the kidneys, diabetes control, weight, and other health risks. Additional research is needed to refine these strategies and better tailor treatments to each situation.
Official Sources
Source Document
DOI: https://doi.org/10.1007/s12325-026-03559-7
Title: Evidence-Based Positioning of Sodium-Glucose Co-transporter 2 Inhibitors and Glucagon-Like Peptide 1 Receptor Agonists in the Management of Chronic Kidney Disease with Type 2 Diabetes and Overweight or Obesity: A Systematic Literature Review
Journal: Advances in Therapy
Publisher: Springer Science and Business Media LLC
Authors: Yehuda Handelsman; Alice Y. Y. Cheng; Gian Paolo Fadini; Pam Kushner; Fabrice Bonnet; Paola Fioretto; Takashi Kadowaki; Naresh Kanumilli; Xavier Cos; Thomas Frese; Linong Ji; Molly Murton; Simon Foulcer; Surendra Pentakota; Peter Rossing