Editorial
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jun 15, 2024; 15(6): 1086-1090
Published online Jun 15, 2024. doi: 10.4239/wjd.v15.i6.1086
New perspectives in the management of diabetic nephropathy
Anna Psyllaki, Konstantinos Tziomalos
Anna Psyllaki, Konstantinos Tziomalos, The First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki 54636, Greece
Author contributions: Psyllaki A drafted the manuscript; Tziomalos K critically revised the draft.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Konstantinos Tziomalos, MD, MSc, PhD, Associate Professor, The First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi Street, Thessaloniki 54636, Greece. ktziomalos@yahoo.com
Received: January 7, 2024
Revised: February 1, 2024
Accepted: March 25, 2024
Published online: June 15, 2024
Processing time: 156 Days and 6.4 Hours
Abstract

Diabetic nephropathy (DN) is the leading cause of end-stage renal disease and is also associated with increased risk for cardiovascular events. Until recently, strict glycemic control and blockade of the renin-angiotensin system (RAS) constituted the mainstay of treatment of DN. However, randomized controlled trials showed that sodium-glucose cotransporter 2 inhibitors further reduce the progression of DN. Therefore, these agents are recommended in all patients with DN regardless of DN stage and HbA1c levels. Moreover, additional blockade of the RAS with finerenone, a selective non-steroidal mineralocorticoid receptor antagonist, was also shown to prevent both the decline of renal function and cardiovascular events in this population. Finally, promising preliminary findings suggest that glucagon-like peptide 1 receptor agonists might also exert reno- and cardioprotective effects in patients with DN. Hopefully, this knowledge will improve the outcomes of this high-risk group of patients.

Keywords: Diabetes mellitus; Diabetic nephropathy; Sodium-glucose cotransporter 2 inhibitors; Finerenone; Glucagon-like peptide 1 receptor agonists; Finerenone

Core Tip: The management of diabetic nephropathy evolved substantially in recent years with the accumulation of evidence showing that sodium-glucose cotransporter 2 inhibitors and potentially finerenone prevent both renal function deterioration and cardiovascular events.