Lactate Metabolism and Protein Lactylation in Diabetic Kidney Disease: A Narrative Review

Diabetic Kidney Disease (DKD) is one of the common and serious microvascular complications of diabetes, and the pathogenesis is complex and incompletely understood. Recent studies have shown that lactylation, as a novel form of protein post-translational modification, has been increasingly involved in the progression of DKD through the specific binding of lactate molecules to protein amino acid residues, particularly involving important pathological processes such as inflammatory regulation, cell death-related signaling pathways and fibrotic remodeling. This review summarizes current evidence on abnormal lactate metabolism in DKD and the mechanisms by which lactate-driven lactylation regulates signaling pathways associated with kidney injury. It further evaluates the potential of lactate as a clinical biomarker and discusses intervention strategies targeting lactate metabolism as well as enzymes involved in lactylation and delactylation. These findings provide new insights and future research directions for the prevention and treatment of DKD.