Advancements in Pharmacotherapy for Diabetic Kidney Disease: A Systematic Review

Abstract

Diabetic kidney disease (DKD), affecting 20–40% of individuals with diabetes, is the leading cause of end-stage renal disease and represents a considerable global public health challenge owing to its high morbidity and mortality rates. Although traditional DKD management has focused on renin-angiotensin system blockade, the residual risk of renal failure persists despite optimised therapy. New therapeutic drugs, including glucagon-like peptide-1 receptor agonists, have triggered a paradigm shift in DKD treatment. Sodium-glucose cotransporter-2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists, and selective endothelin receptor antagonists have shown notable efficacy in improving renal outcomes in patients with type 2 diabetes mellitus. Furthermore, traditional Chinese medicine (TCM), with its holistic approach and evidence-based refinements, has shown considerable promise in DKD treatment, particularly as its theoretical framework continues to evolve. This study highlighted the transformative potential of multitargeted strategies in mitigating DKD progression, improving cardiovascular outcomes, and alleviating healthcare burdens. Future research should prioritise standardised trials, long-term safety assessments of TCM and personalised therapeutic regimens to optimise clinical management and patient quality of life.