{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:39:48Z","timestamp":1792687188128,"version":"4.5.0"},"reference-count":0,"publisher":"Oxford University Press (OUP)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"Abstract<\/jats:title>\n \n Introduction<\/jats:title>\n Experimental and clinical data suggest that the non-specific phosphodiesterase inhibitor pentoxifylline (PTX) reduces proteinuria and may delay the progression of diabetic kidney disease (DKD). However, no large-scale randomized clinical trial has determined whether PTX can reduce end-stage kidney disease (ESKD) and mortality in DKD.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n VA PTXRx is a randomized, double-blind, placebo-controlled, parallel-group, multicenter clinical trial designed to test the hypothesis that PTX, when added to usual care, prolongs the time to kidney failure or death in type 2 diabetic (T2D) participants with DKD compared to usual care plus placebo. Enrolled participants at very high risk for ESKD and\/or death were randomized in a 1:1 ratio to either PTX 400 mg twice daily or matching placebo using randomly permuted blocks with stratification for site, renin-angiotensin-aldosterone (RAAS) inhibitor use, and chronic kidney disease (CKD) stage. The study is event-driven, requiring 646 primary events (ESKD (chronic dialysis or transplantation) or death) to achieve 80% power to detect a relative risk reduction of 19% with PTX.<\/jats:p>\n <\/jats:sec>\n \n Baseline Results<\/jats:title>\n Between December 2019 and November 2025, 2376 participants at 34 VA sites in the USA were randomized. The mean age at randomization was 72.3 years (SD 7.7), with 97% being male. The mean baseline eGFR was 33.3 mL\/min\/1.73 m2 (SD 9.4). The median urinary albumin to creatinine ratio (UACR) was 401 mg\/g (IQR 122-1076). At baseline, the usage of RAAS inhibitors was 80.0%, sodium-glucose transporter-2 (SGLT2) inhibitors 52.9%, glucagon-like peptide-1 (GLP-1) receptor agonists 33.2%, and finerenone 3.0%. The majority (88%) of participants had stage 3B or 4 CKD (eGFR &lt; 45 mL\/min\/1.73m2).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The results, anticipated in 2027, are expected to determine whether PTX is a treatment option for patients with high-risk DKD. Because PTX is a generic medication, it is inexpensive in many health systems, which would facilitate access if it proves effective.<\/jats:p>\n Trial Registration: This study is registered with clinicaltrials.gov (Identifier: NCT03625648).<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/ndt\/gfag245","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T11:48:07Z","timestamp":1792583287000},"source":"Crossref","is-referenced-by-count":0,"title":["The Veterans Affairs Pentoxifylline in Diabetic Kidney Disease (VA PTXRx) Study: Baseline Characteristics"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2078-9948","authenticated-orcid":false,"given":"David J","family":"Leehey","sequence":"first","affiliation":[{"name":"Jr. VA Medical Center Edward Hines, , Hines, IL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8355-7100","authenticated-orcid":false,"given":"Rajiv","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Richard L. Roudebush VA Medical Center , Indianapolis, IN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Xing","sequence":"additional","affiliation":[{"name":"VA Cooperative Studies Program Coordinating Center , Hines, IL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Clise","sequence":"additional","affiliation":[{"name":"VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center , Albuquerque, NM ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sankar","family":"Navaneethan","sequence":"additional","affiliation":[{"name":"Michael E. DeBakey VA Medical Center , Houston, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina","family":"Utzschneider","sequence":"additional","affiliation":[{"name":"VA Puget Sound Health Care System , Seattle, WA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Lammie","sequence":"additional","affiliation":[{"name":"VA Cooperative Studies Program Coordinating Center , Hines, IL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongliang","family":"Wei","sequence":"additional","affiliation":[{"name":"VA Cooperative Studies Program Coordinating Center , Hines, IL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Huminik","sequence":"additional","affiliation":[{"name":"VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center , Albuquerque, NM ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Polzin","sequence":"additional","affiliation":[{"name":"VA Cooperative Studies Program Coordinating Center , Hines, IL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blake","family":"Glomb","sequence":"additional","affiliation":[{"name":"VA Cooperative Studies Program Coordinating Center , Hines, IL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly","family":"Carlson","sequence":"additional","affiliation":[{"name":"VA Cooperative Studies Program Coordinating Center , Hines, IL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,22]]},"container-title":["Nephrology Dialysis Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ndt\/advance-article-pdf\/doi\/10.1093\/ndt\/gfag245\/72303361\/gfag245.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ndt\/advance-article-pdf\/doi\/10.1093\/ndt\/gfag245\/72303361\/gfag245.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:02:17Z","timestamp":1792684937000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ndt\/advance-article\/doi\/10.1093\/ndt\/gfag245\/8971941"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,22]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1093\/ndt\/gfag245","relation":{},"ISSN":["0931-0509","1460-2385"],"issn-type":[{"value":"0931-0509","type":"print"},{"value":"1460-2385","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,22]]},"article-number":"gfag245"}}