Diabetic kidney disease (DKD), defined as co-existing diabetes and chronic kidney disease in the absence of other clear causes of kidney injury, occurs in approximately 20–40% of patients with diabetes mellitus. As the global prevalence of diabetes has increased, DKD has become highly prevalent and a leading cause of kidney failure, accelerated cardiovascular disease, premature mortality and global health care expenditure. Multiple pathophysiological mechanisms contribute to DKD, and single lifestyle or pharmacological interventions have shown limited efficacy at preserving kidney function. For nearly two decades, renin–angiotensin system inhibitors were the only available kidney-protective drugs. However, several new drug classes, including sodium glucose cotransporter-2 inhibitors, a non-steroidal mineralocorticoid antagonist and a selective endothelin receptor antagonist, have now been demonstrated to improve kidney outcomes in people with type 2 diabetes mellitus. In addition, emerging preclinical and clinical evidence of the kidney-protective effects of glucagon-like-peptide-1 receptor agonists has led to the prospective testing of these agents for DKD. Research and clinical efforts are geared towards using therapies with potentially complementary efficacy in combination to safely halt kidney disease progression. As more kidney-protective drugs become available, the outlook for people living with DKD should improve in the next few decades.

糖尿病肾病 (DKD) 被定义为在没有其他明确的肾损伤原因的情况下同时存在糖尿病和慢性肾病，约 20-40% 的糖尿病患者患有糖尿病。随着全球糖尿病患病率的增加，DKD 已变得非常普遍，并且是肾衰竭、心血管疾病加速、过早死亡和全球医疗保健支出的主要原因。多种病理生理机制导致 DKD，单一生活方式或药物干预在保护肾功能方面效果有限。近二十年来，肾素-血管紧张素系统抑制剂是唯一可用的肾脏保护药物。然而，一些新的药物类别，包括钠葡萄糖协同转运蛋白 2 抑制剂、非甾体盐皮质激素拮抗剂和选择性内皮素受体拮抗剂，现已被证明可以改善 2 型糖尿病患者的肾脏结局。此外，胰高血糖素样肽 1 受体激动剂的肾脏保护作用的临床前和临床证据不断涌现，引发了对这些药物治疗 DKD 的前瞻性测试。研究和临床工作旨在联合使用具有潜在互补功效的疗法来安全地阻止肾脏疾病的进展。随着越来越多的肾脏保护药物的出现，未来几十年 DKD 患者的前景应该会有所改善。