{"id":"43b8dcf7203e","type":"article","url":"https://hartvaat.nl/2026/08/18/combinatietherapie-bij-t2dm-en-chronische-nierziekte-evidence-naar-praktijk/","title":"Combinatietherapie bij T2DM en chronische nierziekte — evidence naar praktijk","title_en":"Combination Pharmacotherapy in Type 2 Diabetes and Chronic Kidney Disease: Translating Evidence into Clinical Practice.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association","doi":"10.1093/ndt/gfag136","source_url":"https://doi.org/10.1093/ndt/gfag136","authors":["Julie A Lovshin"],"significance":6,"published":"2026-08-25","source_date":"2026-08-18","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"Chronic kidney disease in type 2 diabetes affects 30–40% of patients and substantially increases cardiovascular risk and mortality. Recent evidence supports the simultaneous use of SGLT2 inhibitors, non-steroidal mineralocorticoid receptor antagonists, GLP-1 receptor agonists, and RAAS blockade to target distinct pathophysiological pathways. This combination strategy reduces cardiovascular events, delays progression to end-stage renal disease, and improves survival. Clinically, it underscores the importance of early, mechanism-driven combination pharmacotherapy in patients with T2DM and CKD.","created":"2026-08-19T00:48:20Z","updated":"2026-08-19T00:48:20Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Chronische nierziekte bij type 2-diabetes komt bij 30-40% van de patiënten voor en verhoogt het cardiovasculaire risico en de mortaliteit aanzienlijk. Recente studies ondersteunen de gelijktijdige inzet van SGLT2-remmers, nsMRA’s, GLP-1-RA’s en RAAS-remming om via verschillende mechanismen zowel de nier- als het cardiovasculaire risico te verlagen. Deze combinatieaanpak leidt tot minder dialysebehoeftigheid, minder cardiovasculaire events en een verbeterde overleving. Voor de klinische praktijk betekent dit dat een gefaseerde, mechanisme-gerichte combinatietherapie de standaard wordt bij T2DM met CKD.","abstract_original":"Development of chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM) is a dual threat, imposing not only increased risk for end-stage renal disease, but also substantially increasing cardiovascular risk and premature mortality¹'³. Its prevalence is staggering, affecting approximately 30-40% of all patients with T2DM¹. Fortunately, advances in pharmacotherapies over the past twenty-five years, including sodium-glucose cotransporter 2 (SGLT2) inhibitors, non-steroidal mineralocorticoid receptor antagonists (nsMRAs), and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) together with blockade of renin angiotensin aldosterone system activation (RAAS) with angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARBs), have transformed the clinical management of T2DM and CKD². By providing parallel reductions in both renal and cardiovascular risk, patients with T2DM and CKD (especially those at higher risk), experience improved survival, fewer cardiovascular events and require less initiation of dialysis as a result of delayed progression to end-stage renal failure⁹-¹⁴'¹⁹. Recent evidence from clinical trials in T2DM and CKD, supports simultaneous use of combinatory phamacotherapies targeting distinct mechanistic pathophysiological pathways¹⁹."}