A Multisystemic Approach to Cardiorenal Metabolic Syndrome: The Impact of Sglt-2 Inhibitors and Angiotensin 2 Receptor Blockers (Arbs) on Disease Progression

Introduction Cardiorenal Metabolic Syndrome (CRMS) is a complex disease that reflects the coexistence of cardiovascular, chronic kidney diseases and metabolic risk factors that are simultaneously affected by accelerated progression [1]. This interplay has a significant clinical impact on morbidity and mortality [2] CRMS is a syndrome that involves almost every organ system in the body, yet there are medications that can help protect against further damage. Case Presentation A 78-year-old patient suffering from type 2 diabetes, gout, hypertension, and stage 3 chronic kidney disease. Objectively he presented with dyspnoea, peripheral edema, and intermittent claudication. In 1985 the patient was diagnosed with type 2 diabetes and hypertension II which were managed by medications but his HbA1c stayed at 9,5%. Since 2014 the patient’s kidneys have started to decline: GFR decreased from 67 to 52 in 2015 and to 43 in 2018 with proteinuria. In 2015 the patient started using an Angiotensin 2 receptor blocker (Valsartan). That helped to slow the decline of GFG. In 2022 the patient added SGLT-2 inhibitors. Since then his GFG reached 39. It only went down by 4 in 6 years compared to 24 from 2014 to 2018. HbA1c 7,8%. He did not reach the target HbA1c (below 7%) because of his lifestyle. The NT-proBNP 7.1 shows that his heart was protected. From that, we can see cardio protection and that the progression of the disease has slowed down. Discussion Today this syndrome is more common due to obesity becoming an epidemic in most of the world [3]. In this case, the patient presented himself with the typical clinical and laboratory results for CRMS (type 2 diabetes, chronic kidney disease, heart failure) and got treatment with Valsartan and SGLT-2 inhibitors. SGLT-2 inhibitors help by blocking the reabsorption of glucose in the proximal tubule therefore lowering the blood glucose levels. ARB treats by blocking angiotensin 2 receptors that way lowering blood pressure [4]. These medications took a multisystemic approach and declined deterioration of the patient’s kidneys and heart failure. Conclusions In this case, we had a patient with type 2 diabetes, hypertension and a steadily declining kidney function receive treatment with ARB and SGLT-2 inhibitor which prolonged the progression of the disease, provided cardio protection and management for CRMS.