Molecular Mechanisms and Clinical Evidence Supporting the Four Pillars of Therapy in Diabetic Kidney Disease: Emerging Therapeutic Perspectives - PubMed
3 hours ago
- #Four Pillars Therapy
- #Emerging Therapeutics
- #Diabetic Kidney Disease
- Diabetic kidney disease (DKD) is a major complication of diabetes and the leading cause of end-stage renal disease globally.
- The four pillars of DKD therapy are renin-angiotensin system inhibitors, non-steroidal MRA, SGLT2 inhibitors, and GLP-1 receptor agonists, with molecular mechanisms explaining their efficacy.
- Risk factors beyond diabetes and hypertension include insulin resistance, dyslipidemia, and hyperuricemia, with metformin, fibrates, and febuxostat showing DKD benefits but requiring caution in renal impairment.
- Newer options like imeglimin, pemafibrate, and dotinurad offer safer alternatives in renal impairment with specific mechanisms to improve DKD, representing emerging therapeutic perspectives.
- The review is narrative, noting that high-evidence research on emerging therapies is lacking and further progress is needed.