Consensus Statement from India on the Renal Benefits of ARNi, SGLT-2i, and Bisoprolol in Chronic Kidney Disease.

H K Chopra,Dinesh Khullar,Tiny Nair,G S Wander,C K Ponde,Saumitra Ray,Navin C Nanda,Ravi R Kasliwal,D S Rana,Ashok Kirpalani,Jps Sawhney,Praveen Chandra,Yatin Mehta,Viveka Kumar,S Tewari,A K Pancholia,Vijay Kher,Sandeep Bansal,Sanjay Mittal,Praful Kerkar,P K Sahoo,Ramesh Hotchandani,Sunil Prakash,Nagendra Chauhan,Vishal Rastogi,A Jabir,S Shanmugasundaram,Mangesh Tiwaskar,Ajay Sinha,Vittul Gupta,S S Mishra,S N Routray,A K Omar,Onkar C Swami,Aparna Jaswal,Shamsad Alam,Rajeev Passey,Rajeeve Rajput,Justin Paul,Aditya Kapoor,D Prabhakar,Subhash Chandra,Poonam Malhotra,Vivudh Pratap Singh,Manish Bansal,Priyank Shah,Sanjay Jain,Mohan Bhargava,I B Vijayalakshmi,Kiron Varghaese,Dharmender Jain,Anupam Goel,Namrata Gaur,Rohit Tandon,Asha Moorthy,Sheeba George,V K Katyal,R R Mantri,Rahul Mehrotra,Dilip Bhalla,Vinod Mittal,Sarita Rao,Manish Jagia,Harmeet Singh,Surabhi Awasthi,Ameet Sattur,Rekha Mishra,Anand Pandey,Rajeev Chawla,Shalini Jaggi,Blessy Sehgal,Alok Sehgal,Naresh Goel,Ripen Gupta,Samir Kubba,Abhinav Chhabra,Saurabh Bagga,N R Shastry

doi:10.59556/japi.72.0543

Abstract

Chronic kidney disease (CKD) is a major contributor to morbidity and mortality in India. CKD often coexists with heart failure (HF), diabetes, and hypertension. All these comorbidities are risk factors for renal impairment. HF and CKD are pathophysiologically intertwined, and the deterioration of one can worsen the prognosis of the other. There is a need for safe renal pharmacological therapies that target both CKD and HF and are also useful in hypertension and diabetes. Neurohormonal activation achieved through the activation of the sympathetic nervous system (SNS), the renin-angiotensin-aldosterone system (RAAS), and the natriuretic peptide system (NPS) is fundamental in the pathogenesis and progression of CKD and HF. Angiotensin receptor neprilysin inhibitor (ARNi), sodium-glucose cotransporter 2 inhibitors (SGLT-2i), and selective β1-blocker (B1B) bisoprolol suppress this neurohormonal activation. They also have many other cardiorenal benefits across a wide range of CKD patients with or without concomitant HF, diabetes, or hypertension. This consensus statement from India explores the place of ARNi, SGLT-2i, and bisoprolol in the management of CKD patients with or without HF and other comorbidities.

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