The landscape of diabetic kidney disease transformed
After nearly two decades, a new therapeutic agent, canagliflozin, received regulatory approval to prevent loss of kidney function, end-stage kidney disease, hospitalization for heart failure and cardiovascular death in patients with diabetic kidney disease.
Nonetheless, the residual risk of kidney disease progression and complications remains high, underlining the importance of ongoing therapeutic development.
- A sodium–glucose cotransporter 2 (SGLT2) inhibitor is now indicated to preserve kidney function and to prevent end-stage kidney disease (ESKD), hospitalization for heart failure and cardiovascular death in diabetic kidney disease (DKD).
- Endothelin blockade is another promising therapeutic approach for DKD when applied after safety assessment for volume retention, irrespective of initial albuminuria reduction.
- Glucagon-like peptide 1 (GLP1) receptor agonists are emerging as effective agents for glycaemic control, atherosclerotic cardiovascular disease risk reduction and estimated glomerular filtration rate (eGFR) preservation, even in patients with advanced stages of DKD.
- Vitamin D and omega-3 fatty acids are ineffective for preventing loss of kidney function or ESKD in patients with DKD.
- Allopurinol did not slow measured GFR decline despite effective uric acid lowering in patients with type 1 diabetes and early DKD.
The year 2019 was pivotal
for the field of diabetic kidney disease (DKD) research as we witnessed a resurgence of discovery being translated into therapeutic innovation. For the first time in nearly two decades, a therapeutic agent received regulatory approval for the prevention of loss of kidney function, end-stage kidney disease (ESKD), hospitalization for heart failure and cardiovascular death in patients with DKD.
Read the complete article in Nature Reviews Nephrology