Microsimulation estimates broad eligibility for combination cardiorenal therapy

A microsimulation published in the Journal of the American Society of Nephrology assessed eligibility for cardiorenal combination therapy using NHANES 2007–2016 and 2017–2020 data from 8,152 adults. Researchers applied 73 guideline recommendations and recent trial inclusion criteria, incorporating acute treatment effects on eGFR, urine albumin-to-creatinine ratio, and serum potassium. Outcomes were treatment eligibility and projected annual all-cause and cardiovascular deaths averted.

An estimated 15% of US adults were eligible for a renin–angiotensin system inhibitor (RASi) plus an SGLT2 inhibitor, including 70% of those with type 2 diabetes, 50% with chronic kidney disease (CKD), and 84% with both. Eligibility for adding a GLP-1 receptor agonist was 11% overall and 69%, 33%, and 83% in these respective subgroups. Quadruple therapy, additionally including a nonsteroidal mineralocorticoid receptor antagonist, had 4% overall eligibility and 40% eligibility among adults with both diabetes and CKD.

Among adults with diabetes, triple therapy was projected to avert twice as many all-cause and cardiovascular deaths as dual therapy despite slightly lower eligibility. Absolute numbers of projected deaths averted were not provided in the supplied text. The findings suggest substantial potential eligibility for combination treatment, but mortality benefits depend on model assumptions and were not demonstrated in a treatment trial. Historical survey data also limit interpretation of reported medication use as reflecting current practice.