Background:Chronic Kidney Disease (CKD) is a progressive and widespread condition affecting millions globally. Despite the use of standard treatments such as renin-angiotensin system (RAS) inhibitors and tight blood pressure control, many patients still experience ongoing decline in estimated glomerular filtration rate (eGFR), increased albuminuria, and eventual progression to end-stage kidney disease. Recently, newer drug classes—including SGLT2 inhibitors, GLP-1 receptor agonists, finerenone, and HIF prolyl hydroxylase inhibitors—have shown potential in slowing this progression.

Aim:To assess the clinical effectiveness of novel medical therapies—beyond standard of care—in reducing kidney function decline, albuminuria progression, and incidence of major renal outcomes in patients with CKD.

Methods:A narrative and quantitative analysis was conducted using published randomized controlled trials (RCTs) and large cohort studies from 20192025. We conducted a retrospective, observational study using patient data from a tertiary nephrology center and supplemented this with findings from large published trials between 2019 and 2025. Primary outcomes included annual change in eGFR, percent reduction in urinary albumin-to-creatinine ratio (uACR), and incidence of ≥30% decline in eGFR. Patients were grouped based on their initiated therapy: standard care, SGLT2 inhibitors, finerenone, or GLP-1 receptor agonists. Statistical analyses included multivariate regression to assess therapy-specific effects, adjusted for baseline renal function and comorbiditie.

Results. SGLT2 inhibitors reduced the rate of CKD progression by 25–40%, showing benefit in both diabetic and non-diabetic patients. Finerenone further reduced albuminuria and risk of eGFR decline in patients already receiving RAS inhibitors. GLP-1 RAs, particularly semaglutide, improved renal and cardiovascular outcomes. Emerging agents like HIF prolyl hydroxylase inhibitors demonstrated renal safety and modest benefits, though long-term evidence remains limited. In our local cohort, patients receiving SGLT2 inhibitors or finerenone had significantly slower eGFR decline and lower rates of progression compared to those on standard care..

Keywords:
Chronic kidney disease; SGLT2 inhibitors; GLP1 receptor agonists; Finerenone; HIFprolyl hydroxylase inhibitors; Kidney function decline; Albuminuria; Novel therapies