Expanding Era of Evidence-Based CKD Care, With Marc Richards, MD

For decades, management of chronic kidney disease (CKD) centered largely on controlling blood pressure, managing diabetes, and using renin-angiotensin system blockade when appropriate. Today, that approach has expanded considerably, with a growing number of disease-modifying therapies targeting distinct pathways involved in kidney injury and progression.

CKD affects more than 1 in 7 US adults, yet many patients remain unaware they have the disease, underscoring the need for earlier recognition and more effective treatment strategies.

The emergence of sodium-glucose cotransporter 2 (SGLT2) inhibitors, nonsteroidal mineralocorticoid receptor antagonists, and other therapies has transformed the clinical approach to slowing CKD progression.

In this Q&A with HCPLive, Marc Richards, MD, a nephrologist at Florida Kidney Physicians, discusses how this expanding evidence base is changing CKD management, the role of combination therapy, and why clinicians should continue adopting new treatment strategies.

Q&A: Expanding Era of Evidence-Based CKD Care, With Marc Richards, MD

HCPLive: When you're thinking about managing chronic kidney disease in 2026, what do you consider the essential components of evidence-based care?

Richards: I think what's amazing is that we actually have evidence-based care now. Up until a few years ago, it was, you know, maybe take care of your blood pressure, take care of your blood sugar, maybe take an ACE inhibitor, and avoid medicines that are bad for the kidneys. And really, outside of that, there was nothing we could really tell patients.

But now our data is exploding. We have evidence with ACE inhibitors and ARBs for proteinuric kidney disease states. We have SGLT2 inhibitors becoming a standard of care. We now have the nonsteroidal MRAs that are on the market, both in diabetic and—now we're learning—non-diabetic kidney disease, that could benefit our patients. Data is emerging with GLP‑1 agonists.

Also, nephrology is teeming with these new clinical trials that can help us really get more medicines to the forefront and have a really good evidence base to manage our patients.

HCPLive: As you’ve mentioned, there are so many new therapies that have emerged in recent years that target very different pathways. How has that shifted your thinking about combination therapy or selecting treatments for individual patients?

Richards: We like that there was the CONFIDENCE trial, which was really recent, where they looked at combining SGLT2 inhibitors with finerenone, which is the nonsteroidal mineralocorticoid receptor antagonist. They showed that you got pretty good reduction in proteinuria with either of those agents, but when you use them together, you actually had a synergistic effect and the protein in the urine got even better.

I think sometimes patients might get a little frustrated when we're adding medicine on top of medicine, but if you explain that they all work together from different angles to protect kidneys, the patients are willing to accept combination therapy.

I don't know if that answered your question totally about the individualized care, but certainly if a patient does have protein in the urine, that would make me more willing to be more aggressive with that type of therapy.

HCPLive: If every nephrologist listening today could make one change in their practice tomorrow, what would you want it to be?

Richards: I really think it's being earlier adopters of this evidence. I think a lot of nephrologists have been sort of swayed to sleep by 20 to 25 years of really no groundbreaking developments in how we manage chronic kidney disease.

We've gone from that to now potentially three new classes of agents on the market, and potentially more, that can delay progression of kidney disease in our patients and prevent progression to end-stage kidney disease.

So I think we just need to wake up and realize that we have this great evidence out there. We have new classes of agents out there that are readily available to use on our patients, and we can really make a difference in the lives of our patients.

HCPLive: Was there anything else that I didn't ask about that you think you would want to highlight or add?

Richards: I think the only other thing would be that in addition to what we now have, we always have the potential for more. At least our practice, and a lot of academic and private practices throughout the country, are very active with clinical research.

Potentially the next great treatment is out there, but we just need to get patients into clinical trials to see if we can establish new standards of care to optimize management of our patients.

Editor’s Note: Richards reports no relevant disclosures.

References

1. National Institute of Diabetes and Digestive and Kidney Diseases. Kidney Disease Statistics for the United States. Updated 2025. Accessed July 17, 2026. https://www.niddk.nih.gov/health-information/health-statistics/kidney-disease

2. Heerspink HJL, Stefánsson BV, Correa-Rotter R, et al. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2020;383(15):1436-1446. doi:10.1056/NEJMoa2024816.