A renaissance in the treatment of diabetic kidney disease, hypertension in chronic kidney disease, and beyond.

Chronic kidney disease (CKD) affects approximately 15% of the US population and is associated with significant cardiovascular morbidity and mortality. The two leading causes of end stage kidney disease are hypertension and diabetes mellitus, both of which are modifiable risk factors. The cornerstones of CKD care include early detection, management of associated risk factors, modification of cardiovascular disease risk, slowing progression of disease, and management of complications including anemia, acid base disturbance, and mineral and bone disorders. For the last 20 years, renin-angiotensin system inhibitors were the mainstay treatment for proteinuric diabetic and nondiabetic kidney disease. Recently, new therapies such as sodium-glucose linked transporter 2 inhibitors, have emerged as powerful tools in the treatment of CKD with indications in both diabetic and nondiabetic kidney disease. In this article, we define CKD staging, review new hypertension and diabetic guidelines for CKD patients, and discuss major trials for new potential therapies in CKD, particularly diabetic kidney disease. We will provide practical guidance for primary care physicians to diagnose CKD and implement these agents early in the disease course to prevent the progression of disease and reduce the morbidity and mortality of this vulnerable population.