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Almost 2 decades ago, treatments targeting the renin\u2010angiotensin system (RAS) were shown to slow the progression of kidney disease. More recently, studies have reported the additive benefits of antihyperglycaemic sodium\u2010glucose co\u2010transporter\u20102 inhibitors in combination with RAS inhibitors on both CKD progression and cardiovascular outcomes. However, these recent data also showed that patients continue to progress to kidney failure or die from kidney\u2010 or cardiovascular\u2010related causes. Therefore, new agents are needed to address this continuing risk. Overactivation of the mineralocorticoid (MR) receptor contributes to kidney inflammation and fibrosis, suggesting that it is an appropriate treatment target in patients with diabetes and CKD. Novel, selective non\u2010steroidal MR antagonists are being studied in these patients, and the results of two large recently completed clinical trials have shown that one such treatment, finerenone, significantly reduces CKD progression and cardiovascular events compared with standard of care. This review summarizes the pathogenic mechanisms of CKD in type 2 diabetes and examines the potential benefit of novel disease\u2010modifying agents that target inflammatory and fibrotic factors in these patients.<\/jats:p>","DOI":"10.1111\/dom.14601","type":"journal-article","created":{"date-parts":[[2021,11,15]],"date-time":"2021-11-15T01:29:58Z","timestamp":1636939798000},"page":"365-376","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":104,"title":["Improving the residual risk of renal and cardiovascular outcomes in diabetic kidney disease: A review of pathophysiology, mechanisms, and evidence from recent trials"],"prefix":"10.1111","volume":"24","author":[{"given":"Ajay","family":"Chaudhuri","sequence":"first","affiliation":[{"name":"Division of Endocrinology and Metabolism Jacobs School of Medicine and Biomedical Sciences, University at Buffalo  Buffalo New York USA"},{"name":"Diabetes Center Kaleida Health  Buffalo New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6333-6033","authenticated-orcid":false,"given":"Husam","family":"Ghanim","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism Jacobs School of Medicine and Biomedical Sciences, University at Buffalo  Buffalo New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pradeep","family":"Arora","sequence":"additional","affiliation":[{"name":"Buffalo VA Medical Center Jacobs School of Medicine and Biomedical Sciences, University at Buffalo  Buffalo New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,12]]},"reference":[{"key":"e_1_2_12_2_1","volume-title":"IDF Diabetes Atlas","author":"International Diabetes Federation","year":"2019"},{"key":"e_1_2_12_3_1","unstructured":"US Centers for Disease Control and Prevention. 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