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.
Key advances
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.
This is a preview of subscription content, access via your institution
Access options
Access Nature and 54 other Nature Portfolio journals
Get Nature+, our best-value online-access subscription
$29.99 / 30 days
cancel any time
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Wanner, C. et al. Empagliflozin and progression of kidney disease in type 2 diabetes. N. Engl. J. Med. 375, 323–334 (2016).
Neal, B. et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N. Engl. J. Med. 377, 644–657 (2017).
Wiviott, S. D. et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N. Engl. J. Med. 380, 347–357 (2019).
Perkovic, V. et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N. Engl. J. Med. 380, 2295–2306 (2019).
Heerspink, H. J. L. et al. Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial. Lancet 393, 1937–1947 (2019).
Mann, J. F. E. et al. Liraglutide and renal outcomes in type 2 diabetes. N. Engl. J. Med. 377, 839–848 (2017).
Tuttle, K. R. et al. Dulaglutide versus insulin glargine in patients with type 2 diabetes and moderate-to-severe chronic kidney disease (AWARD-7): a multicenter, open-label, randomised trial. Lancet Diabetes Endocrinol. 6, 605–617 (2018).
Gerstein, H. C. et al. Dulaglutide and renal outcomes in type 2 diabetes: an exploratory analysis of the REWIND randomised, placebo-controlled trial. Lancet 394, 131–138 (2019).
de Boer, I. H. et al. Effect of vitamin D and omega-3 fatty acid supplementation on kidney function in patients with type 2 diabetes: a randomized clinical trial. JAMA 322, 1899–1909 (2019).
Doria, A. et al. Preventing early renal loss in diabetes (PERL) study: outcome of a 3-year trial of serum uric acid reduction with allopurinol [abstract FR-OR 137]. ASN Kidney week https://www.asn-online.org/education/kidneyweek/2019/program-abstract.aspx?controlId=3274268 (2019).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The author has consulted for Eli Lilly and Company, Boehringer Ingelheim, AstraZeneca, Gilead, Goldfinch Bio, Novo Nordisk and Bayer.
Rights and permissions
About this article
Cite this article
Tuttle, K.R. The landscape of diabetic kidney disease transformed. Nat Rev Nephrol 16, 67–68 (2020). https://doi.org/10.1038/s41581-019-0240-6
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41581-019-0240-6
