Advancing kidney protection in type 1 diabetes: insights from emerging therapies in type 2 diabetes and chronic kidney disease
Abstract
Introduction For decades, the first-line treatment for kidney protection in people with type 1 diabetes (T1D) and chronic kidney disease (CKD) has been limited to intensive glycemic control, renin-angiotensin system blockers and managing modifiable risk factors. Accordingly, risk of CKD progression has remained unacceptably high, emphasizing the need for novel kidney protective therapies in T1D. Areas covered This review summarizes the recent evidence supporting the use of existing treatments used for kidney protection in people with type 2 diabetes (T2D) for potential repurposing for people with T1D. First, we highlight the putative structural and functional changes that actively contribute to CKD progression and highlight key hemodynamic, pro-inflammatory, and kidney injury risk markers in T1D. Next, we discuss emerging nephroprotective therapies targeting these pathophysiological factors, review mechanistic studies that have assessed kidney benefits of these agents in T1D, and highlight ongoing kidney-focused trials in T1D, including SUGARNSALT (NCT06217302), FINE-ONE (NCT05901831) and REMODEL-T1D (NCT05822609). Expert opinion Several medications have become available that could potentially transform CKD care in T1D. It is essential to devise strategies that could address the treatment landscape for kidney protection in T1D by assessing the risk-benefit calculus and expanding the nephrologist's toolkit for minimizing kidney risk in T1D.
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Current evidence of kidney benefit is limited to CKD in type 2 diabetes.
“while current evidence of kidney benefit is limited to CKD in type 2 diabetes, multiple studies are in progress to determine if these therapies also improve kidney outcomes in people with type 1 diabetes (149,150).”
From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [149]
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Liu, H., Sridhar, V. S., Montemayor, D., Lovblom, L. E., Lytvyn, Y., Ye, H., Kim, J., Ali, M. T., Scarr, D., Lawler, P. R., et al. (2021) · Diabetes Obesity and Metabolism · doi:10.1111/dom.14489 · Cited by 35 · see citing works
Self-citationAmatruda, J. G., Katz, R., Sarnak, M. J., Gutiérrez, O. M., Greenberg, J. H., Cushman, M., Waikar, S. S., Parikh, C. R., Schelling, J. R., Jogalekar, M. P., et al. (2022) · Kidney International Reports · doi:10.1016/j.ekir.2022.03.033 · Cited by 35 · see citing works
Cherney, D. Z. I., Scholey, J. W., Daneman, D., Dunger, D. B., Dalton, R. N., Moineddin, R., Mahmud, F. H., Dekker, R., Elia, Y. T., Sochett, E. B., et al. (2012) · Diabetic Medicine · doi:10.1111/j.1464-5491.2012.03651.x · Cited by 34 · see citing works
Self-citationHanrahan, J. P., Seferović, J. P., WAKEFIELD, J. D., Wilson, P. J., Chickering, J. G., Jung, J. O., Carlson, K. E., Zimmer, D. P., Frelinger, A. L., Michelson, A. D., et al. (2019) · Diabetologia · doi:10.1007/s00125-019-05062-x · Cited by 34 · see citing works
Cardinez, N., Lovblom, L. E., Bai, J.-W., Lewis, E. J. H., Abraham, A., Scarr, D., Lovshin, J. A., Lytvyn, Y., Boulet, G., Farooqi, M. A., et al. (2018) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2018.05.001 · Cited by 33 · see citing works
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Cherney, D. Z. I., Hadjadj, S., Lawson, J., Mosenzon, O., Tuttle, K. R., Vrhnjak, B., Rasmussen, S., & Bain, S. C. (2022) · Kidney International Reports · doi:10.1016/j.ekir.2022.07.167 · Cited by 33 · see citing works
Self-citationAre All Patients With Type 1 Diabetes Destined for Dialysis if They Live Long Enough? Probably Not
Bakris, G. L., & Molitch, M. E. (2018) · Diabetes Care · doi:10.2337/dci17-0047 · Cited by 31 · see citing works
Kidney Effects of Empagliflozin in People with Type 1 Diabetes
Cherney, D. Z. I., Bjornstad, P., Perkins, B. A., Rosenstock, J., Neubacher, D., Marquard, J., & Soleymanlou, N. (2021) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.07700621 · Cited by 31 · see citing works
Self-citationThe cyclic GMP–dependent protein kinase Iα suppresses kidney fibrosis
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Hanrahan, J. P., WAKEFIELD, J. D., Wilson, P. J., Mihova, M., Chickering, J. G., Ruff, D. A., Hall, M., Milne, G. T., Currie, M. G., & Profy, A. T. (2018) · Clinical Pharmacology in Drug Development · doi:10.1002/cpdd.627 · Cited by 30 · see citing works
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Mehta, T. H., Bůžková, P., Kizer, J. R., Djoussé, L., Chonchol, M., Mukamal, K. J., Shlipak, M. G., Ix, J. H., & Jalal, D. I. (2017) · BMC Nephrology · doi:10.1186/s12882-017-0509-6 · Cited by 28 · see citing works
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Mechanisms of Cardiorenal Protection of Glucagon-Like Peptide-1 Receptor Agonists
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Bjornstad, P., Pyle, L., Cherney, D. Z. I., Johnson, R. J., Sippl, R., Wong, R., Rewers, M., & Snell‐Bergeon, J. K. (2017) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gfx255 · Cited by 24 · see citing works
Self-citationProgressive renal decline as the major feature of diabetic nephropathy in type 1 diabetes
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Renal Hemodynamic Function and RAAS Activation Over the Natural History of Type 1 Diabetes
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Ambinathan, J. P. N., Sridhar, V. S., Lytvyn, Y., Lovblom, L. E., Liu, H., Bjornstad, P., Perkins, B. A., Lovshin, J. A., & Cherney, D. Z. I. (2021) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2021.107880 · Cited by 17 · see citing works
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11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026
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Butler, J., Jamil, A., Cherney, D. Z. I., Jafar, T. H., Testani, J. M., & Khan, M. S. (2026) · European Heart Journal · doi:10.1093/eurheartj/ehag426 · Cited by 1 · see citing works
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Current State of Cardiorenal Disease in People with Type 1 Diabetes.
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Ni, H., SNAITH, J. R., & Greenfield, J. R. (2026) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2026.04.001
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Targeting kidney disease in type 1 diabetes: progress and promise
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Self-citationPerry, F., Leon, S. J., Polecina, K., Getachew, R., Askin, N., Ferguson, T., Whitlock, R. H., Zheng, Z., Aldworth, C., Katta, A., et al. (2026) · Diabetes Obesity and Metabolism · doi:10.1111/dom.71337
- Authors
- Kugathasan, L., Aronson, Y., Sridhar, V. S., Ni, H., Ouimet, J.-P., Limonte, C. P., Sarma, S., & Cherney, D. Z. I.
- Affiliations
- University Health Network (CA)
- McGill University (CA)
- University of Washington (US)
- University of Toronto (CA)
- Corresponding author
- Cherney, David Z. I.
- ORCID
- Venue
- Expert Review of Clinical Immunology
- Publisher
- Informa UK Limited
- Published
- 2025-07-24
- Volume
- 21
- Issue
- 8
- Pages
- 1113-1134
- ISSN
- 1744-666X (ISSN-L)
- 1744-8409
- OpenAlex
- W4412557969
- Cited by
- 9
- References
- 220
- Citations by year
- 2026: 8 · 2025: 1
- FWCI
- 1.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Expert Review of Clinical Immunology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Keywords
- type 1 diabetes, chronic kidney disease, renal protection, nephroprotective therapy, drug repurposing, type 2 diabetes, chronic kidney disease progression, renin-angiotensin system inhibitors, inflammation, hemodynamics
- MeSH terms
- Animals, Clinical Trials as Topic, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Diabetic Nephropathies, Humans, Hypoglycemic Agents, Kidney, Disease Progression, Renal Insufficiency, Chronic
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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