Drugs for kidney disease
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Emerging and Repurposed Drugs for Kidney Disease
Introduction to Kidney Disease and Current Treatments
Chronic kidney disease (CKD) and acute kidney injury (AKI) are significant global health issues, with CKD being a leading cause of morbidity and mortality due to its progression to end-stage renal disease (ESRD) . The primary pharmacological treatments for CKD currently include angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), which help manage blood pressure and reduce inflammation and fibrosis. However, the need for novel drugs to more effectively slow the progression of renal function loss remains critical.
Emerging Drugs for Chronic Kidney Disease
Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors
SGLT2 inhibitors have shown promise in treating diabetic kidney disease (DKD), a major cause of ESRD. The CREDENCE trial demonstrated the efficacy of canagliflozin, an SGLT2 inhibitor, in reducing the progression of DKD. These inhibitors not only help in glucose control but also offer renal protection, making them a valuable addition to the treatment arsenal for DKD .
Novel Antihyperglycemic Agents
New generations of antihyperglycemic drugs, such as non-steroidal mineralocorticoid receptor antagonists, have been developed to reduce side effects like hyperkalemia, making them suitable for CKD patients. These drugs have shown potential in slowing the decline of glomerular filtration rate (GFR) and improving cardiovascular outcomes.
Incretin-Related Drugs
Incretin-related drugs have demonstrated renoprotective abilities in various clinical trials. These drugs are currently being evaluated with renal outcomes as their primary endpoint, indicating their potential in managing CKD.
Repurposed Drugs for Kidney Disease
Chemokine Receptor Inhibitors and p53 Inhibitors
Repurposing existing drugs for new clinical indications offers a cost-effective and time-efficient approach. The chemokine receptor inhibitor CCX140 and the p53 inhibitor QPI-1002 are currently being explored for their potential in treating CKD and AKI, respectively.
Glucose-Lowering Drugs
Glucose-lowering drugs such as SGLT2 inhibitors, glucagon-like peptide-1 (GLP-1) agonists, and metformin have shown renal and cardiovascular protective effects beyond their primary use in diabetes management. These drugs are being repurposed for broader applications in CKD treatment.
Xanthine Oxidase Inhibitors and Endothelin Receptor Antagonists
Xanthine oxidase inhibitors (e.g., allopurinol, febuxostat) and selective endothelin receptor antagonists (e.g., atrasentan) are also being repurposed for CKD due to their potential to reduce oxidative stress and inflammation.
Novel Drug Delivery Technologies
Nanomedicines and Targeted Drug Delivery
Emerging drug delivery technologies, such as nanomedicines, offer promising strategies for targeting drugs specifically to kidney cells. These technologies aim to enhance drug efficacy and reduce side effects by ensuring precise renal uptake and distribution . However, challenges such as solubility, toxicity, and optimal renal targeting need to be addressed before these technologies can be widely adopted in clinical practice .
Conclusion
The treatment landscape for kidney disease is evolving with the development of novel drugs and the repurposing of existing ones. SGLT2 inhibitors, novel antihyperglycemic agents, and incretin-related drugs are among the promising new treatments for CKD and DKD. Additionally, repurposed drugs like chemokine receptor inhibitors and xanthine oxidase inhibitors offer new hope for managing kidney disease. Advances in drug delivery technologies further enhance the potential for effective and targeted treatments. Continued research and clinical trials are essential to bring these promising therapies to patients and improve outcomes in kidney disease management.
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