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Novel Therapeutic Strategies for Patients With CKD and Diabetes Mellitus

Luxcia Kugathasan1, Alexandra Katz2, Marcel H A Muskiet1,3

  • 1Division of Nephrology, Department of Medicine, University Health Network, Toronto, Ontario, Canada.

Kidney International Reports
|May 28, 2026
PubMed

Insights

New therapies are emerging to combat chronic kidney disease (CKD) in diabetes mellitus. These treatments target multiple pathways to reduce cardiorenal risk and slow kidney disease progression.

Area of Science:

  • Nephrology
  • Endocrinology
  • Pharmacology

Background:

  • Diabetic kidney disease (DKD) is a major cause of end-stage kidney disease (ESKD) and mortality.
  • Despite current treatments, significant cardiorenal risk persists in patients with diabetes mellitus (DM).
  • Novel therapeutic strategies are needed to address complementary pathophysiological pathways in DKD.

Purpose of the Study:

  • To review emerging therapies for slowing CKD progression in patients with DM.
  • To highlight the clinical rationale and evidence for novel treatment strategies.
  • To discuss challenges in translating these advances into clinical practice.

Main Methods:

  • Review of current literature on novel therapeutic agents for DKD.
  • Exploration of multitargeting incretin-based therapies.
  • Examination of aldosterone synthase inhibitors, endothelin receptor antagonists (ERAs), and soluble guanylate cyclase agonists.
  • Discussion of emerging therapies like kidney autologous cell therapy and anti-inflammatory agents.
  • Consideration of challenges in type 1 diabetes mellitus (T1D) management.

Main Results:

  • Multitargeting incretin-based therapies offer potential metabolic and kidney benefits.
  • Aldosterone synthase inhibitors and ERAs demonstrate anti-inflammatory, hemodynamic, and antifibrotic effects.
  • Soluble guanylate cyclase agonists improve kidney perfusion and reduce albuminuria.
  • Emerging cell and anti-inflammatory therapies show promise in targeting key disease pathways.

Conclusions:

  • Novel therapies, including incretin-based drugs, aldosterone synthase inhibitors, ERAs, and soluble guanylate cyclase agonists, represent a promising evolution in DKD treatment.
  • These agents have the potential to complement existing therapies and address key mechanisms of DKD progression.
  • Ongoing trials are crucial to define the role of these therapies in the standard of care for DKD.
  • Addressing economic and access barriers is vital for equitable uptake of new treatments, especially for type 1 diabetes mellitus patients.

Keywords:
aldosterone synthase inhibitorschronic kidney diseasediabetesendothelin receptor antagonistsincretin-based therapiesmineralocorticoid receptor antagonist

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