Diabetes and its associated complications pose an immediate threat to humankind. Diabetic kidney disease is one of the most devastating complications, increasing the risk of death more than ten-fold over the general population. Until very recently, the only drugs proven and recommended to slow the progression of diabetic kidney disease were angiotensin-converting enzyme inhibitors and angiotensin II type 1 receptor blockers, which act by inhibiting the renin-angiotensin system. Despite their efficacy as kidney and cardiovascular protective therapies and as antihypertensive agents, renin-angiotensin system inhibitors have been grossly underutilized. Moreover, even when renin-angiotensin system inhibitors are used, patients still have a high residual risk of diabetic kidney disease progression. Finally, the kidney-protective effect of renin-angiotensin system inhibitors has been categorically demonstrated only in patients with macroalbuminuria included in the Irbesartan Diabetic Nephropathy Trial (IDNT) and Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) trials, not in other individuals. The lack of new therapies to treat diabetic kidney disease over the past 2 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.

糖尿病及其相关并发症对人类构成直接威胁。糖尿病肾病是最具破坏性的并发症之一，其死亡风险是普通人群的十倍以上。直到最近，唯一被证明和推荐减缓糖尿病肾病进展的药物是血管紧张素转换酶抑制剂和血管紧张素 II 1 型受体阻滞剂，它们通过抑制肾素-血管紧张素系统发挥作用。尽管肾素-血管紧张素系统抑制剂作为肾脏和心血管保护疗法以及抗高血压药物具有功效，但其利用却严重不足。此外，即使使用肾素-血管紧张素系统抑制剂，患者仍然存在糖尿病肾病进展的高残留风险。最后，肾素-血管紧张素系统抑制剂的肾脏保护作用仅在厄贝沙坦糖尿病肾病试验 (IDNT) 和血管紧张素 II 拮抗剂洛沙坦 (RENAAL) 试验中减少 NIDDM 终点的大量白蛋白尿患者中得到明确证实，而没有得到证实。在其他个体中。因此，过去 20 年来缺乏治疗糖尿病肾病的新疗法，这对患者和医疗保健提供者都构成了巨大的挑战。近年来，出现了许多强大的新疗法，有望改变糖尿病和肾病患者的护理。社区面临的挑战是确保这些治疗方法的快速实施。 本白皮书重点介绍了治疗方面的进展、患者面临的机遇、挑战以及促进肾脏健康的可能解决方案，并介绍了美国肾脏病学会发起的糖尿病肾病合作组织，以帮助实现这些目标。