New pharmacological strategies for protecting kidney function in type 2 diabetes

Marcel H. A. Muskiet, David C. Wheeler, Hiddo J. L. Heerspink

Research output: Contribution to journalReview articleAcademicpeer-review

62 Citations (Scopus)


Type 2 diabetes is the leading cause of impaired kidney function, albuminuria, and renal replacement therapy globally, thus placing a large burden on health-care systems. Current treatment strategies rely on intensive glucose lowering as well as strict blood pressure control through blockade of the renin–angiotensin–aldosterone system. Such approaches might slow decline in kidney function, but many patients progress to end-stage kidney failure despite optimal therapy. In recent clinical trials, new-generation glucose-lowering drug classes, the sodium-glucose co-transporter-2 inhibitors and agents that target the incretin pathway, have been shown to improve kidney outcomes in patients with type 2 diabetes. Other new approaches, which have been developed on the basis of an improved understanding of the mechanisms that contribute to kidney damage in the context of diabetes, include use of drugs that block endothelin receptors (eg, atrasentan) and non-steroidal mineralocorticoid receptors (eg, finerenone). In this Review, we provide an overview of recent clinical data relevant to these new therapeutic approaches for management of kidney disease in the context of type 2 diabetes.
Original languageEnglish
Pages (from-to)397-412
JournalThe Lancet Diabetes and Endocrinology
Issue number5
Publication statusPublished - 1 May 2019

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