Optimal use of sodium-glucose co-transporter 2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in chronic kidney disease (CKD) and Type 2 diabetes mellitus (T2DM) remains uncertain. A two-round international Delphi panel published in Advances in Therapy evaluated expert consensus on the foundational and adjunctive roles of these therapies in cardiorenal management.

The Delphi panel included 114 participants from 10 countries and was conducted between August 29 and October 20, 2025. Statement development was guided by a systematic literature review and input from 12 global experts. Consensus was predefined as at least 75% agreement or disagreement.

Findings

• Consensus was achieved for 13 of 30 statements in Round 1 and 7 of 17 statements in Round 2.
• Panelists agreed that SGLT2 inhibitors should be used as foundational therapy in adults with CKD and T2D, regardless of body mass index (BMI).
• GLP-1 receptor agonists were considered appropriate add-on therapy in adults with BMI ≥35 kg/m² and cardiometabolic complications or comorbidities, including residual glycated hemoglobin A1c (HbA1c) elevation and atherosclerotic cardiovascular disease.
• Combination therapy with SGLT2is and GLP-1 RAs was considered appropriate in patients with ongoing kidney disease progression, elevated cardiovascular risk, or suboptimal metabolic control.

The panel findings supported prioritization of SGLT2 inhibitors as foundational therapy for cardiorenal risk reduction in adults with CKD and T2D. GLP-1 receptor agonists were generally viewed as adjunctive therapy in patients with persistent kidney disease progression or high cardiometabolic risk.