{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T17:24:01Z","timestamp":1789147441780,"version":"build-2803163510"},"reference-count":50,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,11,23]],"date-time":"2025-11-23T00:00:00Z","timestamp":1763856000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Diabetes mellitus (DM) continues to be a global world health problem. Despite medical advances, both DM and chronic kidney disease (CKD) remain global health issues with high mortality and limited options to prevent end-stage renal failure. Current therapies encompass five classes of drugs: (1) angiotensin-converting-enzyme inhibitors (ACEI) or angiotensin II receptor blockers (AIIRB); (2) sodium-glucose-transporter 2 (SGLT2) inhibitors; (3) glucagon-like peptide-1 receptor agonists (GLP-1 RA); and (4) an antagonist of type 1 endothelin receptor (ET1R) with proven efficacy to reduce albuminuria and proteinuria. (5) The mineralocorticoid receptor antagonist (MRA) finerenone has been tested in RCTs as a kidney protective agent. In our review, we summarize many of the principal trials that have generated evidence in this regard. Many novel agents\u2014many of them proven not only for DM management but also for the treatment of obesity with or without DM or heart failure (HF)\u2014are now in development and may be added to the five classical pillars: other non-steroidal MRA (balcinrenone); aldosterone synthase inhibitors (baxdrostat and vicadrostat); other GLP-1 RA (tirzepatide, survodutide, retatrutide, and cagrilintide); ET1 R antagonists, (zibotentan); and soluble guanylate cyclase activators (avenciguat). These new agents aim to slow disease progression further and reduce cardiovascular risk. Future strategies rely on integrated, patient-centered approaches and personalized therapy to curb renal disease and its related complications.<\/jats:p>","DOI":"10.3390\/jcm14238326","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T16:31:54Z","timestamp":1764088314000},"page":"8326","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Diabetes Mellitus and Chronic Kidney Disease: The Future Is Being Surpassed"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3889-5578","authenticated-orcid":false,"given":"Alberto","family":"Mart\u00ednez-Castelao","sequence":"first","affiliation":[{"name":"Nephrology Department, Bellvitge University Hospital, Hospitalet, 08907 Barcelona, Spain"},{"name":"GEENDIAB (Grupo Espa\u00f1ol de Estudio de la Nefropat\u00eda Diab\u00e9tica), Sociedad Espa\u00f1ola de Nefrolog\u00eda (S.E.N.), 39008 Santander, Spain"},{"name":"RED in REN-RICORS 2040, Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1134-9051","authenticated-orcid":false,"given":"Jos\u00e9 Luis","family":"G\u00f3rriz","sequence":"additional","affiliation":[{"name":"Servicio de Nefrolog\u00eda, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain"},{"name":"GEENDIAB-S.E.N., 39008 Santander, Spain"},{"name":"RICORS2040 (RD24\/004\/0022), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz","family":"Fern\u00e1ndez-Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"GEENDIAB (Grupo Espa\u00f1ol de Estudio de la Nefropat\u00eda Diab\u00e9tica), Sociedad Espa\u00f1ola de Nefrolog\u00eda (S.E.N.), 39008 Santander, Spain"},{"name":"Servicio de Nefrolog\u00eda, Fundaci\u00f3n Jim\u00e9nez D\u00edaz, 28040 Madrid, Spain"},{"name":"RICORS2040-Renal, Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3621-0766","authenticated-orcid":false,"given":"Mar\u00eda Jos\u00e9","family":"Soler","sequence":"additional","affiliation":[{"name":"GEENDIAB-S.E.N., 39008 Santander, Spain"},{"name":"RICORS2040-Renal, Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Servicio de Nefrolog\u00eda, Hospital Universitari Vall d\u2019Hebr\u00f3n, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5015-7474","authenticated-orcid":false,"given":"Juan F.","family":"Navarro-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"GEENDIAB-S.E.N., 39008 Santander, Spain"},{"name":"RICORS2040 (RD24\/004\/0022), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Unidad de Investigaci\u00f3n y Servicio de Nefrolog\u00eda, Hospital Universitario Nuestra Se\u00f1ora de Candelaria, 38010 Santa Cruz de Tenerife, Spain"},{"name":"Instituto de Tecnolog\u00edas Biom\u00e9dicas, Universidad de La Laguna, 38010 Santa Cruz de Tenerife, Spain"},{"name":"Facultad de Ciencias de la Salud, Universidad Fernando Pessoa Canarias, 35450 Las Palmas de Gran Canaria, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,23]]},"reference":[{"key":"ref_1","unstructured":"NCD Risk Factor Collaboration (NCD-RisC) (2024). 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