Dual Nephroprotective Strategy of Dapagliflozin and Telmisartan in the Management of Diabetic Kidney Disease: A Comprehensive Review

Abstract

Diabetic Kidney Disease (DKD) is a leading cause of End-Stage Renal Disease (ESRD) worldwide, contributing substantially to morbidity and mortality among patients with Type 2 Diabetes Mellitus (T2DM). Its pathogenesis involves a complex interplay of metabolic and hemodynamic alterations, including hyperglycemia-induced oxidative stress, inflammation, glomerular hypertension, and progressive fibrosis. Despite the availability of current monotherapies, many patients experience continued renal function decline, highlighting the need for more effective treatment strategies. Combining pharmacological agents with complementary mechanisms offers a promising approach to slowing DKD progression. Telmisartan, an Angiotensin II Receptor Blocker (ARB) with partial peroxisome Proliferator-Activated Receptor-Gamma (PPAR-γ) agonist activity, reduces intraglomerular pressure and mitigates fibrosis and inflammation. Dapagliflozin, a Sodium-Glucose Cotransporter 2 (SGLT2) inhibitor, promotes glycosuria, improves renal hemodynamics, and exerts anti-inflammatory and antifibrotic effects independent of glucose lowering. Evidence from preclinical and clinical studies suggests that their combined use provides synergistic nephroprotective benefits, including significant reductions in albuminuria, preservation of estimated Glomerular Filtration Rate (eGFR), improved metabolic control, reduced systemic inflammation, and lowered cardiovascular risk. The combination is generally well tolerated, although careful monitoring is recommended in advanced stages of Chronic Kidney Disease (CKD). This review consolidates current evidence on the dual nephroprotective strategy of dapagliflozin and telmisartan, underscoring its potential role in optimizing outcomes for patients with DKD.

Keywords: Dapagliflozin; Telmisartan; Diabetic Kidney Disease; Nephroprotection; SGLT2 inhibitors; ARBs