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Diabetic kidney disease in 2023

Targeted identification of risk and treatment of diabetic kidney disease

  • Year in Review
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From Nature Reviews Nephrology

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Basic discovery and clinical trials in diabetic kidney disease (DKD) have continued to be reported in 2023 despite the disruption of research activity by COVID-19 in recent years. Advances in clinical trials and emerging ways to diagnose, monitor and treat DKD dominate the current literature.

Key advances

  • Preservation of the glomerular endothelial glycocalyx has been established as a key mechanism by which mineralocorticoid receptor antagonists confer renoprotection in diabetic kidney disease (DKD)3.

  • Glucagon-like peptide-1 receptor agonists are likely to emerge as alternative or additional therapeutics for cardiorenal protection7.

  • Leukocyte methylation correlates with baseline kidney function, and novel methylation sites predict patients with type 2 diabetes who are at risk of kidney failure; these findings may enable the identification of patients who could benefit from early intervention8.

  • Mesenchymal stem cell therapy to treat DKD continues to show promise in pre-clinical models, although clinical trials are yet to be progressed9,10.

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References

  1. The EMPA-KIDNEY Collaborative Group. Empagliflozin in patients with chronic kidney disease. N. Engl. J. Med. 388, 117–127 (2023).

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  2. Agarwal, R. et al. Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis. Eur. Heart J. 43, 474–484 (2022).

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Author information

Authors and Affiliations

  1. Renal Research Laboratory, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia

    Sarah J. Glastras & Carol A. Pollock

  2. North Precinct, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia

    Sarah J. Glastras & Carol A. Pollock

  3. Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, St Leonards, New South Wales, Australia

    Sarah J. Glastras

  4. Department of Renal Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia

    Carol A. Pollock

Authors
  1. Sarah J. Glastras
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  2. Carol A. Pollock
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Corresponding author

Correspondence to Carol A. Pollock.

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Competing interests

S.J.G. has received honoraria for presentations and advisory board roles from Astra Zeneca, Bayer, Boehringer Ingelheim, Eli Lilly and Novo Nordisk. C.A.P. has received honoraria for presentations and advisory board roles from Astra Zeneca, Bayer, Eli Lilly, Boehringer Ingelheim and Otsuka.

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Glastras, S.J., Pollock, C.A. Targeted identification of risk and treatment of diabetic kidney disease. Nat Rev Nephrol 20, 75–76 (2024). https://doi.org/10.1038/s41581-023-00796-9

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  • DOI: https://doi.org/10.1038/s41581-023-00796-9

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