Chronic kidney disease (CKD) is associated with increased morbidity and mortality, especially from cardiovascular (CV) causes, and especially in people with diabetes mellitus (DM). Already the presence of DM increases CV risk and potentiates the risk of CKD. Therefore, besides glycemic control, prevention and treatment of CKD to slow its progression are of clinical importance. A significant nephroprotective effect of novel antidiabetic drugs, namely sodium-glucose cotransporter 2 inhibitors (SGLT2-I) and glucagon-like peptide 1 receptor agonists (GLP1-RA), has been shown on top of their glucose-lowering effects and was confirmed in cardiovascular outcome trials. GLP1-RA mainly reduced the risk of macroalbuminuria, whereas SGLT2-I were also associated with a lower risk of declining glomerular filtration rate (GFR) over time. The nephroprotective effects of SGLT2-I are also evident in people without DM. According to current guidelines, SGLT2-I and/or GLP1-RA are recommended for people with DM who have chronic kidney disease and/or increased cardiovascular risk. However, other antidiabetic drugs offer nephroprotective properties, which will also be discussed in this review.

Die Therapie der chronischen Niereninsuffizienz (CKD) bei Diabetes mellitus (DM) fokussierte sich bisher auf die Gabe von Angiotensin-Converting-Enzyme-Hemmern (ACE-Hemmern) oder Angiotensin-II-Rezeptor-Subtyp-1-Antagonisten (AT₁-Antagonisten). Weiterhin erfolgte die Kontrolle von Risikofaktoren wie Hyperglykämie, arterieller Hypertonie und Hyperlipidämie. Mit Natrium-Glukose-Kotransporter-2-Inhibitoren (SGLT-2i), Glukagonähnliches-Peptid-1-Rezeptor-Agonisten (GLP-1-RA) und einem nichtsteroidalen Mineralokortikoid-Rezeptor-Agonisten stehen neue Therapieoptionen zur Verfügung, die kardiorenale Endpunkte verbessern. Weitere Medikamentenklassen wie Endothelin-Rezeptor-Antagonisten, Aldosteron-Synthetase-Inhibitoren und Inkretin-Hormon-Therapeutika befinden sich in der klinischen Erprobung. Durch die Vielzahl der neuen Optionen wird die zukünftige Herausforderung in der Individualisierung der Therapie und Identifikation von Hochrisikopatienten liegen. Article published online: 21 July 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany