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DIABETIC KIDNEY DISEASE IN 2018

A promising outlook for diabetic kidney disease

In 2018, consolidating evidence for renoprotective benefits was seen with respect to sodium–glucose cotransporter 2 inhibitors and glucagon-like peptide 1 agonists, which are currently being incorporated into clinical practice. The focus now turns to novel therapeutic targets to optimize renoprotection as diabetic kidney disease grows to epidemic proportions worldwide.

Key advances

  • The CANVAS Program reported renal benefits of canagliflozin1; these findings build on evidence from the EMPA-REG OUTCOME trial7 for a renoprotective effect of sodium–glucose cotransporter 2 (SGLT2) inhibitors.

  • The AWARD-7 trial reported renal benefits of dulaglutide2; these results add weight to previous findings of renoprotective effects of glucagon-like peptide 1 (GLP1) agonists.

  • Targeting podocyte histone modification via promotion of H3K27me3 prevented glomerular cell dedifferentiation and loss of renal function in a mouse model of obesity and type 2 diabetes mellitus3.

  • Inhibition of apoptosis signal-regulating kinase 1 (ASK1) prevented oxidative stress and fibrosis and was renoprotective in a mouse model; human trials of ASK1 inhibition in diabetic kidney disease are underway4.

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Fig. 1: Diabetic kidney disease in 2018: current therapies and novel targets.

References

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Correspondence to Mark Cooper.

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Cooper, M., Warren, A. A promising outlook for diabetic kidney disease. Nat Rev Nephrol 15, 68–70 (2019). https://doi.org/10.1038/s41581-018-0092-5

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