title: New strategies to tackle diabetic kidney disease.
abstract: The purpose of this review is to provide an overview of recent preclinical and clinical studies, which demonstrate new insights for the treatment of diabetic kidney disease (DKD) and to outline future directions with respect to novel therapies.
  
  
  
  Positive findings with respect to new glucose-lowering agents such as sodium-dependent glucose transporter 2 inhibitors may lead to a change in the way we treat diabetic individuals with or at risk of DKD. Additional positive phase 2 clinical studies with drugs that have hemodynamic actions such as endothelin antagonists and mineralocorticoid receptor antagonists have led to larger phase 3 trials with atrasentan and finerenone, respectively, in order to address if these drugs indeed delay the development of end-stage renal disease. A number of other pathways are currently under active preclinical investigation and hopefully over the next decade will lead to promising drug candidates for subsequent clinical trials.
  
  
  
  DKD remains an area of active preclinical and clinical investigation. Positive results with some of the more promising agents should lead to strategies to reverse, attenuate or prevent DKD.
authors.affiliation: aDiabetes Domain, Baker IDI Heart and Diabetes Institute bDepartment of Medicine, Central Clinical School, Monash University cDepartment of Endocrinology and Diabetes, Alfred Health, Melbourne, Victoria, Australia.
authors.forename: Duygu
authors.initials: D
authors.lastname: Batu Demir
authors.forename: Mark E
authors.initials: ME
authors.lastname: Cooper
mesh_terms: D057912:Angiotensin II Type 2 Receptor Blockers / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D000077868:Atrasentan; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000378:metabolism; D003928:Diabetic Nephropathies / Q000188:drug therapy*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000627:therapeutic use*; D018450:Disease Progression; D065128:Endothelin Receptor Antagonists / Q000627:therapeutic use*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D009287:Naphthyridines / Q000627:therapeutic use; D011759:Pyrrolidines / Q000627:therapeutic use; D012077:Renal Artery / Q000294:innervation; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy*; D000077203:Sodium-Glucose Transporter 2 Inhibitors; D013562:Sympathectomy
chemical_list: D057912:Angiotensin II Type 2 Receptor Blockers; D000959:Antihypertensive Agents; D054873:Dipeptidyl-Peptidase IV Inhibitors; D065128:Endothelin Receptor Antagonists; D007004:Hypoglycemic Agents; D000451:Mineralocorticoid Receptor Antagonists; D009287:Naphthyridines; D011759:Pyrrolidines; D000077203:Sodium-Glucose Transporter 2 Inhibitors; C576501:finerenone; D000077868:Atrasentan