PHARMACOLOGICAL ADVANCES IN THE MANAGEMENT OF CHRONIC KIDNEY DISEASE (CKD): A COMPREHENSIVE REVIEW

Background: Chronic kidney disease (CKD) represents a major and escalating global health challenge, contributing significantly to morbidity, mortality, and healthcare costs across low-, middle-, and high-income countries. Despite established management strategies—such as blood pressure control, glycaemic regulation, and renin–angiotensin system (RAS) blockade—residual renal and cardiovascular risks remain high, and many patients progress to end-stage kidney disease. Objective: This review aims to comprehensively synthesize recent pharmacological advances in CKD management, emphasizing novel therapeutic mechanisms, pivotal clinical trial evidence, safety considerations, and implications for clinical practice and guidelines. Methods: A narrative review was conducted by examining recent landmark randomized controlled trials, guideline updates (KDIGO, ADA), and systematic reviews indexed in PubMed and related databases, focusing on therapies targeting renal hemodynamics, inflammation, fibrosis, oxidative stress, and metabolic dysregulation. Results: Breakthroughs in CKD pharmacotherapy include sodium–glucose cotransporter-2 (SGLT2) inhibitors, which confer robust reno- and cardioprotective effects across diabetic and non-diabetic CKD populations; non-steroidal mineralocorticoid receptor antagonists (e.g., finerenone), which reduce inflammation, fibrosis, and adverse cardiorenal outcomes; and adjunctive therapies such as newer potassium binders (patiromer, sodium zirconium cyclosilicate) enabling sustained RAS blockade. Additional agents—hypoxia-inducible factor prolyl-hydroxylase inhibitors for anemia, glucagon-like peptide-1 receptor agonists, endothelin receptor antagonists, and microbiome-directed interventions—are emerging as important complements to standard care. Evidence supports a paradigm shift toward multimodal, layered pharmacological strategies addressing both traditional and non-traditional pathways. Conclusion: Pharmacological management of CKD is rapidly evolving beyond conventional risk-factor control. Integration of SGLT2 inhibitors, selective MRAs, and supportive agents into standard regimens has the potential to substantially improve renal and cardiovascular outcomes. Future priorities include optimizing combination strategies, refining patient selection, and addressing residual risks through therapies targeting inflammation, fibrosis, and the gut–kidney axis.