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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.

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.

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Fig. 1: Positive kidney outcomes from the CREDENCE and SONAR clinical trials.


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Correspondence to Katherine R. Tuttle.

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Competing interests

The author has consulted for Eli Lilly and Company, Boehringer Ingelheim, AstraZeneca, Gilead, Goldfinch Bio, Novo Nordisk and Bayer.

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Tuttle, K.R. The landscape of diabetic kidney disease transformed. Nat Rev Nephrol 16, 67–68 (2020).

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