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What Are The Best Medications For Treating diabetic nephropathy?

What Are The Best Medications For Treating Diabetic Kidney Disease

Diabetic nephropathy, once a large amount of proteinuria appears, is indeed challenging. If effective control is not achieved, it will progress to uremia within a few years. Previously, for the renal protection treatment of diabetic nephropathy, apart from angiotensin receptor blockers or ACE inhibitors, there really wasn’t a better method. Five years ago, the introduction of SGLT-2 inhibitors brought about the second revolution in the treatment of diabetic nephropathy. Beyond its blood sugar-lowering effects, its ability to reduce proteinuria and protect the kidneys has elevated the treatment of diabetic nephropathy to a new level.

According to statistics, about one-third of diabetes patients will experience kidney complications. Diabetic nephropathy caused by diabetes has surpassed glomerulonephritis to become the leading cause of kidney disease globally. It is expected that in a few years, it will also become the primary reason for uremia and dialysis.

The progression from diabetes to diabetic nephropathy and then to uremia is not an overnight occurrence; it involves a lengthy process. During this period, with careful attention and control of three key indicators, kidney damage can be delayed, kidney function can be protected, and the occurrence of uremia can be avoided.

These three key indicators are blood sugar, blood pressure, and urine protein. The three classes of therapeutic drugs are angiotensin receptor blockers or ACE inhibitors (RAS blockers), SGLT-2 inhibitors (SGLT2 inhibitors), and the third generation of aldosterone receptor antagonists.

Three key indicators for controlling diabetic nephropathy

Controlling Blood Sugar

Long-term high blood sugar is undoubtedly the fundamental cause of diabetic nephropathy. Maintaining stable and standardized blood sugar levels over the long term can slow down the decline in kidney function and protect kidney function.

However, intensifying blood sugar control may increase the risk of hypoglycemic events and cardiovascular death. Therefore, individualized control targets should be established based on factors such as age, duration of diabetes, life expectancy, complications, comorbidities, and the risk of hypoglycemia.

Whether it is fasting blood sugar or postprandial blood sugar, it should be controlled within the normal range, with Time in Range (TIR) >50%. The commonly used target for blood sugar control is glycated hemoglobin (HbA1c), which, for diabetic nephropathy patients, should be maintained below 7%. Younger and generally healthier patients can aim for levels below 6.5%, while older individuals and those with poorer kidney function may have slightly relaxed targets.

For lowering blood sugar in diabetic nephropathy, SGLT-2 inhibitors are the preferred class of drugs. Three commonly used peptide-based blood sugar-lowering drugs (GLP-1 receptor agonists), liraglutide, dulaglutide, and semaglutide, have clear effects in reducing urine protein and cardiovascular protection. They also provide some level of kidney protection and can be used in combination.

Causes and Diagnosis of Diabetic Kidney Disease 1

Controlling Blood Pressure

Diabetes often coexists with high blood pressure, and even if hypertension was not present initially, it frequently develops after the onset of diabetic nephropathy. Regardless of the cause, persistent hypertension is a major contributor to the decline in kidney function. Strictly controlling blood pressure to meet standards can delay kidney damage and stabilize kidney function.

The blood pressure control target for diabetic nephropathy is below 130/80 mmHg. According to the latest KDIGO guidelines, using standard office blood pressure measurement methods, systolic blood pressure should be controlled below 120 mmHg.

Blood pressure management should be integrated throughout the treatment of diabetic nephropathy. Angiotensin receptor blockers or ACE inhibitors are the preferred antihypertensive medications, and either one can be chosen, but they should not be used in combination.

Controlling Urine Protein

High blood sugar and high blood pressure lead to increased glomerular filtration, high perfusion, and high pressure in the kidneys. Over time, the kidneys become overwhelmed, and the filtration membrane of the glomerulus becomes damaged. Proteins from the blood, including albumin, then leak into the urine, forming proteinuria.

If proteinuria is not controlled promptly, prolonged and excessive protein in the urine can, in turn, accelerate kidney damage. Controlling urine protein can delay kidney damage and stabilize kidney function.

Urine protein is a marker of kidney damage, and the quantity of urine protein can reflect the severity of the condition and assess the effectiveness of treatment. The target for controlling urine protein in diabetic nephropathy is to keep the quantitative urine protein as low as possible, ideally below 1.0g/d, and preferably below 0.3g/d. The lower, the better.

Measures to control urine protein should also be integrated throughout the treatment of diabetic nephropathy.

Three medicine for treating diabetic nephropathy

Angiotensin Receptor Blockers (ARBs) or ACE Inhibitors

Both of these drug classes act on angiotensin II, where ARBs block its action, and ACE inhibitors reduce its production. Besides their blood pressure-lowering effects, both have the added benefits of reducing urine protein and providing kidney protection, making them the preferred antihypertensive medications for diabetic nephropathy. Even if blood pressure is not high, they should be used when proteinuria is present in diabetic nephropathy.

The dosage for reducing urine protein is generally higher than that for lowering blood pressure. As long as blood pressure is tolerable, doses can be used at 2 to 4 times the standard antihypertensive dosage. Since the effects of these two drug classes overlap, combining them doesn’t significantly increase efficacy but does markedly increase side effects. Therefore, guidelines recommend choosing only one of them and explicitly advise against their combined use.

SGLT-2 Inhibitors

SGLT-2 inhibitors are a relatively new class of antidiabetic drugs that have been introduced in recent years. Apart from their blood sugar-lowering effects, they also exhibit significant reduction in urine protein and demonstrate benefits such as slowing down kidney damage, protecting kidney function, preventing uremia, safeguarding cardiovascular health, and managing heart failure. Currently, they have been approved for use in patients with diabetes as well as in individuals with non-diabetic chronic kidney disease and non-diabetic heart failure.


Third-Generation Aldosterone Receptor Antagonists

The currently available medication in this class is finerenone. Apart from its blood pressure-lowering effects, it also demonstrates the ability to reduce urine protein and provide kidney protection. It has been approved for use in the treatment of diabetic nephropathy.

Increasing evidence suggests that elevated aldosterone levels, in conjunction with the action of angiotensin II, contribute to water and sodium retention, pro-inflammatory effects, fibrotic effects, and oxidative stress. This interaction can lead to myocardial infarction and heart failure in the heart and glomerulosclerosis and renal fibrosis in the kidneys, inducing kidney damage and loss of kidney function. Therefore, selectively blocking the overactivation of aldosterone receptors is a novel target in the treatment of diabetic nephropathy.

The results of the completed large-scale clinical studies FIDELIO-DKD, FIGARO-DKD, and FIDELITY indicate that, in patients with controlled blood sugar and blood pressure, and maximal use of angiotensin receptor blockers or ACE inhibitors, finerenone can still significantly reduce urine protein, decrease the risk of new-onset proteinuria, and significantly lower the risk of composite renal outcomes (renal function decline, uremia, and renal death) by 23%. It also significantly reduces the risk of composite cardiovascular outcomes (myocardial infarction, stroke, and cardiovascular death) by 14%. These findings confirm a clear renal and cardiovascular protective effect of finerenone.

In terms of safety, compared to the commonly used first-generation aldosterone receptor antagonist spironolactone and the second-generation aldosterone receptor antagonist eplerenone, finerenone has a more even distribution in the heart and kidneys, achieving a 1:1 distribution. This allows for dual benefits in both the kidneys and the heart. Additionally, it exhibits higher selectivity and affinity for aldosterone receptors, with less impact on androgen hormones and a lower risk of hyperkalemia. With a broad applicability and promising prospects, finerenone is poised to bring about a third significant advancement in the treatment of diabetic nephropathy.

How to Find Affordable Finerenone

It’s widely known that the treatment for type 2 diabetes, RYBELSUS® (semaglutide) tablets, comes with a high cost of up to $995 for 30 tablets. Similarly, the medication for treating diabetic kidney disease, Kerendia finerenone tablets, can be as expensive as $670 for 30 tablets. The exorbitant prices of these medications undoubtedly add to the challenges faced by patients in their daily lives.

Is there an equally effective but more affordable medication available? The answer is LUCIFINE finerenone tablets produced by Lucius Pharmaceuticals. LUCIFINE finerenone tablets are a diabetes kidney disease treatment that has received approval from the Laotian Ministry of Health and is manufactured in Lucius Pharmaceuticals’ GMP factory in Laos, as approved by the U.S. FDA.

LUCIFINE finerenone tablets are not only a legitimately authorized medication but also come at a very affordable price, being only one-third the cost of Kerendia finerenone tablets while delivering the same efficacy.

LUCIFINE finerenone tablets
LUCIFINE finerenone tablets

DKD Care Center serves as the authoritative global distributor for LUCIFINE finerenone tablets, and we possess the necessary authorization certificates from Lucius Pharmaceuticals. The introduction of this new medication comes with significant discounts. If you have been suffering from diabetic kidney disease for an extended period, please don’t hesitate to contact us promptly:

Phone: +852 6993858

WhatsApp: +852 9506 4225



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