Therapeutic advances in diabetic kidney disease: 30 years of evidence and the rise of the “Fantastic Four” in nephrology
Background: Diabetic kidney disease (DKD) remains the leading cause of chronic kidney disease and kidney failure worldwide. Over the past 3 decades, management has evolved from strict glycemic and blood pressure control to targeted therapies that modify disease progression. Summary: The DCCT/EDIC (1...
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| Main Authors: | , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
January-December 2026
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| In: |
Cardiorenal Medicine
Year: 2026, Volume: 16, Issue: 1, Pages: 44-57 |
| ISSN: | 1664-5502 |
| DOI: | 10.1159/000550423 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1159/000550423
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| Author Notes: | Faeq Husain-Syed, Goekhan Yuecel, Clara Daschner, Jan Jochims, Babak Yazdani |
| Summary: | Background: Diabetic kidney disease (DKD) remains the leading cause of chronic kidney disease and kidney failure worldwide. Over the past 3 decades, management has evolved from strict glycemic and blood pressure control to targeted therapies that modify disease progression. Summary: The DCCT/EDIC (1993) confirmed the impact of intensive glycemic and multifactorial risk factor management. But the early 1990s established the foundation of nephroprotective therapy with the Captopril Trial (1993) in type 1 diabetes and subsequent IRMA-1 (2001), IDNT (2001), and the RENAAL (2001) studies established renin-angiotensin-system blockade as the first disease-specific therapy. More than a decade later, sodium-glucose cotransporter-2 (SGLT2) inhibitors transformed care, with EMPA-REG OUTCOME (2015) and CANVAS (2017) studies first demonstrating kidney benefits as secondary outcomes, which were confirmed in subsequent dedicated kidney trials: CREDENCE (2019), DAPA-CKD (2020), and EMPA-KIDNEY (2022) studies, demonstrating consistent reductions in kidney failure and cardiovascular mortality. Finerenone further advanced outcomes in FIDELIO-DKD (2020) and FIGARO-DKD (2021), and combination therapy with SGLT2 inhibition showed additive benefit in the CONFIDENCE (2025) study. Most recently, the FLOW (2024) trial confirmed glucagon-like peptide-1 receptor agonists (GLP-1 RAs) as promising fourth pillar of nephroprotective therapies. Key Messages: Together, these advances, termed the “Fantastic Four,” have redefined standards of care in DKD. This review synthesizes pivotal clinical trials and highlights evolving strategies to guide individualized treatment and future research. |
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| Item Description: | Online veröffentlicht: 13. Januar 2026 Gesehen am 23.03.2026 |
| Physical Description: | Online Resource |
| ISSN: | 1664-5502 |
| DOI: | 10.1159/000550423 |