Heerspink HJL, et al. - In this double-blind, randomized, placebo-controlled trial, researchers investigated the long-term effects of atrasentan treatment on major renal outcomes in people with type 2 diabetes. The study sample consisted of adults (18-85 years old) with type 2 diabetes, an estimated glomerular filtration rate of 25–75 mL/min/1.73 m² of body surface area, and urine albumin-to-creatinine ratio of 300-5,000 mg/g who had received maximum labelled or tolerated renin-angiotensin system inhibition for ≥ 4 weeks. During an enrichment period prior to 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 effectiveness and safety, atrasentan decreased the risk of renal events. A potential role in protecting renal function in type 2 diabetes patients at high risk of developing end-stage kidney disease for selective endothelin receptor antagonists was supported in this analysis.