Clinical) Trial and Error in Diabetic Nephropathy

Patients with diabetes and nephropathy face a high risk of end-stage renal disease (ESRD) and cardiovascular disease. Trials in the past decades of nephrology research have shown the importance of lowering glucose, blood pressure, and albuminuria as a mean to lower renal and cardiovascular risk in these patients. However, despite the promising and successful results from RAAS inhibition with angiotensin receptor blockers in combination with tight glycemic and blood pressure control, many patients with diabetes and nephropathy are left with a high residual risk and still progress to ESRD. The high residual risk highlights the urgent need for additional therapies. This chapter reviews the clinical trial landscape in diabetic nephropathy and draws lessons for future clinical trials in this area.