Chronic kidney disease (CKD) affects approximately 37 million Americans and is a major driver of cardiovascular mortality and morbidity. It is classified by estimated glomerular filtration rate (eGFR) — stage 1 (eGFR ≥90) through stage 5 (eGFR <15, requiring renal replacement therapy) — and by the degree of proteinuria. Most patients with early CKD are asymptomatic, with detection dependent on routine blood and urine screening. The landmark CREDENCE and DAPA-CKD trials established SGLT2 inhibitors as the most important advance in CKD management since ACE inhibitors — reducing CKD progression and cardiovascular events in patients with proteinuric CKD regardless of diabetes status. Finerenone, a non-steroidal mineralocorticoid receptor antagonist, provides additional cardiorenal protection in diabetic CKD.
