Pharmacy Daily | Unlocking benefits of new CKD drugs

FOR the first time in 20 years, two new classes of drugs have become available in Australia for the treatment of diabetic kidney disease, the most common cause of kidney failure.

Both are "extremely effective, safe, and relatively affordable, however, too few people with kidney disease are using these breakthrough drugs", said Prof Vlado Perkovic, Dean of the Faculty of Medicine and Health, UNSW Sydney, who was involved in developing these drugs, along with other Australian researchers who have led the way in identifying their benefits.

"We can only unlock these benefits if healthcare professionals like pharmacists, patients, and the broader community have a greater awareness of kidney disease, and the tools we have to fight it," Perkovic said.

Chronic kidney disease (CKD) is a gradual loss of the kidney's ability to filter waste and excess fluid from the blood.

"It's quite insidious," said Perkovic.

"In Australia, kidney disease affects an estimated one in 10 people, but most won't be aware they have it until it is quite advanced, and at the point of diagnosis, many people are at risk of progressing to kidney failure."

So what is needed is to prevent people with kidney disease from developing kidney failure, he said.

In the 90s, blood pressure-lowering drugs, especially ACE inhibitors and angiotensin receptor blockers were started.

These helped, but only lowered the risk of kidney failure by about 20%, Perkovic explained.

Then for over 20 years, there were a huge number of clinical trials for different treatments trying to produce additional benefits, all of which were unsuccessful.

In the last few years, everything has changed, Perkovic said.

"We have two new classes of drugs, SGLT2 inhibitors, and finerenone.

"The SGLT2 inhibitors are probably the single most effective treatment we have, reducing the risk of kidney failure by 30-40%.

"They have an array of additional benefits, including reducing the risk of heart failure and stroke, lowering blood pressure, and reducing weight.

"And they're remarkably simple to take, just a once-daily tablet," he said.

SGLT2 inhibitors are available in Australia, and they cost the government about $50 per month per person, but they cost the individual less as they are reimbursed through the PBS.

Another medication called finerenone is also approved in Australia and may soon be covered by the PBS, and there is a wide pipeline of other potentially kidney-protective drugs currently being tested, Perkovic said.

"We're at the beginning of a new era," he stated.

"We've spent decades trying to find effective treatments, and finally we've got them.

"Now, the challenge is getting the treatments to the people that need them," Perkovic concluded.