Heerspink HJL, et al. - Because short-term treatment with low-dose atrasentan for people with type 2 diabetes has been shown to reduce albuminuria without significant sodium retention, researchers investigated the long-term effects of atrasentan treatment on major renal outcomes in this double-blind, randomized, placebo-controlled trial. Study participants included adults (aged 18–85 years) with type 2 diabetes, estimated glomerular filtration rate (eGFR) of 25–75 mL/min/1.73 m² of body surface area, and urine albumin-to-creatinine ratio (UACR) of 300–5000 mg/g who had received maximum labelled or tolerated renin-angiotensin system inhibition for ≥ 4 weeks. During an enrichment period before random group assignment, participants were given atrasentan 0.75 mg orally daily. In patients with diabetes and chronic kidney disease who were selected to optimize efficacy and safety, atrasentan decreased the risk of renal events. Findings from this study support a potential role in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease for selective endothelin receptor antagonists.