Chronic kidney disease (CKD) is rapidly becoming a socioeconomic and great public health problem in the world. Moreover, increased life expectancy and the rapid increase in diabetes mellitus lead to a high incidence of diabetic kidney disease (DKD) which is the leading cause of end-stage renal disease and the main disease for renal replacement therapy. DKD is a major cause of morbidity and mortality in diabetic patients worldwide. Since the complexity of mechanisms of DKD and heterogeneous clinical presentation, there are still high medical unmet needs for the management of DKD. However, recent major clinical trials propose some promise in this field. Most remarkable novel treatments that reduce the progression of DKD and improve the risk of cardiovascular events in diabetic patients with CKD are sodium-glucose cotransporter 2 (SGLT-2) inhibitors, glucagon-like peptide 1 (GLP-1) receptor agonists, and the selective nonsteroidal mineralocorticoid receptor antagonist (MRA).
However, the residual risk for progression of renal disease is still high and the rate of progression is still higher than the rate for the normal aging process. Although there is huge progress in the management of blood pressure and hyperglycemia, there are still controversies about the optimal target of blood pressure and glycemic management, especially in patients with advanced CKD.
In addition, different response to treatment is due to the heterogeneity of DKD, and new strategies to improve the management of DKD suggest novel biomarker that predicts the progression and treatment response.
This special issue of Kidney Research and Clinical Practice contains five different topics for the recent update of DKD. Tong and Adler [1] the comprehensive approach to the management of DKD to reduce the progression of renal disease and minimize the risk for cardiovascular events based on the latest published data. Lee et al. [2] gives an overview of the role of NADPH oxidase in DKD, and offer a theoretical basis for the development of various Nox inhibitor as a regulator of reactive oxygen species homeostasis to provide an emerging new therapeutic approach for DKD. Pak et al. [3] present the role of adenosine and adenosine receptor (AR) in the development and progression of DKD. They propose AR modulator as a new therapeutic option to treat DKD based on the mechanistic studies on the pharmacology of AR modulators. Maruno et al. [4] describe the novel therapeutic medications for DKD classified by their pathophysiological targets. Jung and Yoo [5] provide the biomarkers used in current clinical practice and summarize the promising novel biomarkers for DKD based on protein biomarkers, proteomics, metabolomics, and transcriptomics.
Five publications address important issues relevant to DKD. The articles in this special issue demonstrate the high scientific level in this field and encourage us to continue future clinical and experimental research activities in this field. Based on these considerations, we have assembled leading world experts to prepare this Supplement issue to Kidney Research and Clinical Practice by both nephrologists and basic scientists in an attempt to illustrate the current and new diagnostic and therapeutic strategies.
Guest Editor of Kidney Research and Clinical Practice
Dae Ryong Cha
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