From the Research
There is currently no strong evidence that tau-targeting medications for central nervous system (CNS) disorders can improve diabetic kidney disease. Tau-targeting drugs like lecanemab and donanemab are primarily being developed for Alzheimer's disease and other neurodegenerative conditions where tau protein forms pathological aggregates in the brain. While there are some shared pathological mechanisms between neurodegenerative diseases and diabetic nephropathy, such as inflammation and oxidative stress, the specific role of tau protein in kidney disease is not well established. Current standard treatments for diabetic kidney disease focus on blood glucose control, blood pressure management with ACE inhibitors or ARBs, and SGLT2 inhibitors like empagliflozin or dapagliflozin which have demonstrated kidney-protective effects, as shown in a recent review 1. These medications address the underlying mechanisms of diabetic kidney disease including glomerular hyperfiltration, inflammation, and fibrosis. Some key points to consider when treating diabetic kidney disease include:
- The use of SGLT2 inhibitors, which have been shown to slow the progression of kidney disease and reduce the risk of cardiovascular events 2, 3, 4
- The importance of blood pressure management with ACE inhibitors or ARBs, which can help to reduce proteinuria and slow kidney disease progression 3, 5
- The potential benefits of combining SGLT2 inhibitors with other medications, such as ACE inhibitors or ARBs, to provide additional kidney protection 2, 3 Research into connections between tau pathology and kidney disease is ongoing, but at present, patients with diabetic kidney disease should adhere to established treatment protocols rather than pursuing tau-targeting therapies, which remain experimental even for their primary CNS indications. The most recent and highest quality study on this topic, published in 2022, supports the use of SGLT2 inhibitors as a promising therapeutic option for patients with diabetic and non-diabetic CKD to slow disease progression 1.