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A Narrative Review of Diabetic Kidney Disease: Previous and Current Evidence-Based Therapeutic Approaches

Akira Mima1

  • 1Department of Nephrology, Osaka Medical and Pharmaceutical University, Osaka, 569-8686, Japan. akira.mima@ompu.ac.jp.

Advances in Therapy
|June 25, 2022
PubMed

Insights

Diabetic kidney disease (DKD) treatments have advanced beyond renin-angiotensin system (RAS) inhibitors. Sodium-glucose co-transporter 2 (SGLT2) inhibitors and incretin-based agents offer new therapeutic options for DKD management.

Area of Science:

  • Nephrology
  • Endocrinology
  • Pharmacology

Background:

  • Diabetic kidney disease (DKD) is a major complication of diabetes and a leading cause of chronic kidney disease (CKD).
  • Existing treatments, like renin-angiotensin system (RAS) inhibitors, provide partial efficacy.
  • Novel therapeutic strategies are crucial for managing DKD progression and its associated risks.

Purpose of the Study:

  • To review established and emerging therapeutic drugs for diabetic kidney disease (DKD).
  • To highlight recent advancements in DKD pharmacotherapy based on clinical trial evidence.
  • To identify key drug classes forming the current standard of care for DKD.

Main Methods:

  • Literature review focusing on clinical trials and established evidence for DKD treatments.
  • Analysis of drug efficacy and safety profiles for various therapeutic agents.
  • Synthesis of findings to define the current landscape of DKD pharmacotherapy.

Main Results:

  • Sodium-glucose co-transporter 2 (SGLT2) inhibitors (empagliflozin, canagliflozin, dapagliflozin) significantly reduce albuminuria and slow DKD progression.
  • Incretin-based agents (GLP-1 receptor agonists, DPP-4 inhibitors) show potential benefits due to vasotropic actions.
  • Non-steroidal mineralocorticoid receptor antagonists (MRAs), such as finerenone, demonstrate efficacy without significant hyperkalemia.

Conclusions:

  • The current mainstay treatments for DKD include RAS inhibitors, SGLT2 inhibitors, incretin-based agents, and non-steroidal MRAs.
  • These four classes of drugs represent a significant advancement in managing DKD.
  • Further research and clinical application of these agents are essential for improving outcomes in diabetic kidney disease.
Keywords:
Diabetic kidney diseaseDipeptidyl peptidase 4 inhibitorsEnd-stage kidney diseaseGlucagon-like peptide 1Mineralocorticoid receptor antagonistsRenin–angiotensin system inhibitorsSodium-glucose co-transporter 2 inhibitors

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