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Treatment of Diabetic Kidney Disease: Current and Future

Diabetic kidney disease (DKD) is the major cause of end-stage kidney disease. However, only renin-angiotensin system inhibitor with multidisciplinary treatments is effective for DKD. In 2019, sodium-glucose cotransporter 2 (SGLT2) inhibitor showed efficacy against DKD in Canagliflozin and Renal Even...

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Detalles Bibliográficos
Autores principales: Yamazaki, Tomotaka, Mimura, Imari, Tanaka, Tetsuhiro, Nangaku, Masaomi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Diabetes Association 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850867/
https://www.ncbi.nlm.nih.gov/pubmed/33508907
http://dx.doi.org/10.4093/dmj.2020.0217
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author Yamazaki, Tomotaka
Mimura, Imari
Tanaka, Tetsuhiro
Nangaku, Masaomi
author_facet Yamazaki, Tomotaka
Mimura, Imari
Tanaka, Tetsuhiro
Nangaku, Masaomi
author_sort Yamazaki, Tomotaka
collection PubMed
description Diabetic kidney disease (DKD) is the major cause of end-stage kidney disease. However, only renin-angiotensin system inhibitor with multidisciplinary treatments is effective for DKD. In 2019, sodium-glucose cotransporter 2 (SGLT2) inhibitor showed efficacy against DKD in Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) trial, adding a new treatment option. However, the progression of DKD has not been completely controlled. The patients with transient exposure to hyperglycemia develop diabetic complications, including DKD, even after normalization of their blood glucose. Temporary hyperglycemia causes advanced glycation end product (AGE) accumulations and epigenetic changes as metabolic memory. The drugs that improve metabolic memory are awaited, and AGE inhibitors and histone modification inhibitors are the focus of clinical and basic research. In addition, incretin-related drugs showed a renoprotective ability in many clinical trials, and these trials with renal outcome as their primary endpoint are currently ongoing. Hypoxia-inducible factor prolyl hydroxylase inhibitors recently approved for renal anemia may be renoprotective since they improve tubulointerstitial hypoxia. Furthermore, NF-E2–related factor 2 activators improved the glomerular filtration rate of DKD patients in Bardoxolone Methyl Treatment: Renal Function in chronic kidney disease/Type 2 Diabetes (BEAM) trial and Phase II Study of Bardoxolone Methyl in Patients with Chronic Kidney Disease and Type 2 Diabetes (TSUBAKI) trial. Thus, following SGLT2 inhibitor, numerous novel drugs could be utilized in treating DKD. Future studies are expected to provide new insights.
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spelling pubmed-78508672021-02-08 Treatment of Diabetic Kidney Disease: Current and Future Yamazaki, Tomotaka Mimura, Imari Tanaka, Tetsuhiro Nangaku, Masaomi Diabetes Metab J Review Diabetic kidney disease (DKD) is the major cause of end-stage kidney disease. However, only renin-angiotensin system inhibitor with multidisciplinary treatments is effective for DKD. In 2019, sodium-glucose cotransporter 2 (SGLT2) inhibitor showed efficacy against DKD in Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) trial, adding a new treatment option. However, the progression of DKD has not been completely controlled. The patients with transient exposure to hyperglycemia develop diabetic complications, including DKD, even after normalization of their blood glucose. Temporary hyperglycemia causes advanced glycation end product (AGE) accumulations and epigenetic changes as metabolic memory. The drugs that improve metabolic memory are awaited, and AGE inhibitors and histone modification inhibitors are the focus of clinical and basic research. In addition, incretin-related drugs showed a renoprotective ability in many clinical trials, and these trials with renal outcome as their primary endpoint are currently ongoing. Hypoxia-inducible factor prolyl hydroxylase inhibitors recently approved for renal anemia may be renoprotective since they improve tubulointerstitial hypoxia. Furthermore, NF-E2–related factor 2 activators improved the glomerular filtration rate of DKD patients in Bardoxolone Methyl Treatment: Renal Function in chronic kidney disease/Type 2 Diabetes (BEAM) trial and Phase II Study of Bardoxolone Methyl in Patients with Chronic Kidney Disease and Type 2 Diabetes (TSUBAKI) trial. Thus, following SGLT2 inhibitor, numerous novel drugs could be utilized in treating DKD. Future studies are expected to provide new insights. Korean Diabetes Association 2021-01 2021-01-22 /pmc/articles/PMC7850867/ /pubmed/33508907 http://dx.doi.org/10.4093/dmj.2020.0217 Text en Copyright © 2021 Korean Diabetes Association https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review
Yamazaki, Tomotaka
Mimura, Imari
Tanaka, Tetsuhiro
Nangaku, Masaomi
Treatment of Diabetic Kidney Disease: Current and Future
title Treatment of Diabetic Kidney Disease: Current and Future
title_full Treatment of Diabetic Kidney Disease: Current and Future
title_fullStr Treatment of Diabetic Kidney Disease: Current and Future
title_full_unstemmed Treatment of Diabetic Kidney Disease: Current and Future
title_short Treatment of Diabetic Kidney Disease: Current and Future
title_sort treatment of diabetic kidney disease: current and future
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850867/
https://www.ncbi.nlm.nih.gov/pubmed/33508907
http://dx.doi.org/10.4093/dmj.2020.0217
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