Thursday 12 March marked World Kidney Day and health experts warn that chronic kidney disease (CKD) can dramatically increase the risk of life-threatening heart problems. People living with CKD are far more likely to develop cardiovascular disease (CVD) – including heart failure, stroke, coronary artery disease or arrhythmias – making early detection and treatment critical.
Adding to the complexity, chronic kidney disease and heart failure frequently occur with another comorbidity, type 2 diabetes, a triad of conditions health professionals increasingly describe as a “cardio-renal-metabolic” system, where dysfunction in one organ can trigger problems in the others.
“The metabolic system is closely interlinked with the heart and kidneys, and these organs rely on one another to maintain the body’s balance,” explains Ingrid Singels, Associate Director of Pharma Dynamics’ Scientific Division. “The heart depends on the kidneys to regulate fluid balance, while the kidneys rely on the heart for proper blood flow.”
With World Kidney Day approaching on 13 March, health experts are urging people to be aware of this heart-kidney-metabolic connection and to act early. CKD often shows no obvious symptoms at first and many people don’t realise they have kidney problems until significant damage has occurred.
Recognising these links, Singels notes that protecting your kidneys isn’t just about kidney health – it’s about safeguarding your overall well-being. “This is why early screening, education and evidence-based treatments are so important.”
New treatments
Singles explains that in recent years, new types of medicines are changing how CKD is treated.
“One example is empagliflozin, a sodium-glucose co-transporter-2 (SGLT2) inhibitor originally developed for type 2 diabetes. This has shown to protect both kidney function and heart health across many patients. By lowering pressure in the kidneys and improving metabolism, SGLT2 inhibitors can slow disease progression and reduce the risk of kidney failure and heart complications.”
According to current evidence, SGLT2 inhibitors can delay kidney disease progression meaning patients may live longer without needing dialysis or a transplant – a huge benefit for many.
These medicines also protect the heart. Clinical studies show SGLT2 inhibitors cut the risk of heart failure, hospital visits for heart problems and related deaths in people with and without diabetes. Their kidney-protective effects work across different stages of CKD, independent of blood sugar control.
Another important development is the expanded approval of semaglutide for adults with type 2 diabetes and CKD. While originally developed to improve glucose control, semaglutide has demonstrated broader protective effects in large clinical trials.
The pivotal FLOW trial, published in the New England Journal of Medicine in 2024, found semaglutide reduced adverse kidney events – including progression to end-stage kidney disease – by about 24% in people with CKD and type 2 diabetes. It also lowered the risk of major heart problems and death, showing it can protect multiple organs at once.
“This is a major step forward for people at high risk of both kidney and heart disease,” says Singels. “Semaglutide’s ability to protect both the kidneys and the heart represents a new frontier in patient care. These innovations highlight why personalised treatment that considers the whole patient is so important.”
While therapies, such as SGLT2 inhibitors (empagliflozin) and GLP-1 receptor agonists (semaglutide) are transforming the management of diabetes and chronic kidney disease (CKD), access in South Africa is still limited. Many treatments are mainly available in the private sector and high out-of-pocket costs make them hard to reach for uninsured and lower-income patients.
Singels says the launch of quality-assured generic versions could make a real difference. “As cost-effective options become available, more South Africans may benefit from medicines shown to slow kidney disease and protect the heart. Expanding access to clinically appropriate SGLT2 inhibitors and GLP-1 receptor agonists is key to tackling the country’s growing kidney and heart disease burden.”
What patients should do
Singels encourages South Africans – particularly those living with diabetes or hypertension – to take proactive steps by asking their healthcare provider the following questions:
- Are my blood sugar, blood pressure and cholesterol levels well-controlled?
- What lifestyle modifications could help lower my risk in the long term?
- Do I have any risk factors for kidney disease? Risk factors include a family history of kidney disease, obesity or cardiovascular disease.
- Is it necessary for me to test my kidney function or the protein in my urine?
- Would a kidney- and heart-protective treatment, like an SGLT2 inhibitor or GLP-1 receptor agonist, be suitable for my condition?
This World Kidney Day, Pharma Dynamics joins global health organisations in calling for more awareness campaigns, broader screening programmes and greater investment in kidney research and treatment innovation. With early detection and the right medicines, we can change the course of CKD and heart disease – offering hope to millions at risk.
