Transforming the Care of Patients with Diabetic Kidney Disease.

Document Type


Publication Date


Publication Title

Clin J Am Soc Nephrol


washington; spokane


Diabetes and its associated complications pose an immediate threat to humankind. Diabetic kidney disease (DKD) is one of the most devastating complications, increasing the risk of death more than 10-fold over that in the general population [1]. Until very recently, the only drugs proven and recommended to slow progression of DKD were angiotensin-converting enzyme (ACE) inhibitors and angiotensin II type 1 receptor blockers (ARBs), which act by inhibiting the renin-angiotensin system (RAS) [2]. Despite their efficacy as kidney and cardiovascular protective therapies and as antihypertensive agents, RAS inhibitors have been grossly underutilized [3]. Moreover, even when RAS inhibitors are used, patients still have a high residual risk of DKD progression [1, 2]. Finally, the kidney-protective effect of RAS inhibitors has been categorically demonstrated only in patients with macro-albuminuria included in the IDNT and RENAAL trials - not in other individuals [4]. The lack of new therapies to treat DKD over the past two decades has therefore represented a tremendous challenge for patients and health care providers alike. In recent years, a number of powerful new therapies have emerged that promise to transform care of patients with diabetes and kidney disease. The challenge to the community is to ensure rapid implementation of these treatments. This white paper highlights advances in treatment, opportunities for patients, challenges and possible solutions to advance kidney health and introduces the launch of the Diabetic Kidney Disease Collaborative at the American Society of Nephrology, to aid in accomplishing these goals.

Clinical Institute

Kidney & Diabetes