Dipeptidyl Peptidase-4 Inhibitors and Diabetic Kidney Disease: A Narrative Review

Abstract: Diabetic kidney disease is one of the most frequent complications in patients with diabetes mellitus and impacts morbidity and mortality. Recent therapies include oral hypoglycemic drugs that, in addition to optimizing glycemic control and reducing the risk of hypoglycemia, may impact the development and progression of diabetic kidney disease; these novel therapies include inhibitors of the enzyme dipeptidyl peptidase 4, an oral hypoglycemic therapy that acts at the level of the incretin system. DPP-4 inhibitors show additional pleiotropic effects in vitro models, reducing inflammation, fibrosis and oxidative damage, further suggesting potential kidney protective effects. While existing trials suggest possible benefit in the progression of diabetic kidney disease, further studies are needed to demonstrate kidney specific benefits of DPP-4 inhibitors.