We have read with great interest the commentary of Agarwal et al.1Agarwal R. Rifkin B. Moderating effects in randomized trials—interpreting the P value, confidence intervals, and hazard ratios.Kidney Int Rep. 2022; 7: 371-374Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar titled "Moderating Effects in Randomized Trials—Interpreting the P Value, Confidence Intervals, and Hazard Ratios" published in this issue of the KI Reports, where the authors comment on the article published by Provenzano et al.2Provenzano M. Jongs N. Vart P. et al.The kidney protective effects of the sodium–glucose cotransporter-2 inhibitor, dapagliflozin, are present in patients with CKD treated with mineralocorticoid receptor antagonists.Kidney Int Rep. 2022; 7: 436-443https://doi.org/10.1016/j.ekir.2021.12.013Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar and expose the evidence of the renal and cardiovascular benefits of 2 groups of drugs—SGLT2 inhibitors and mineralocorticoid receptor antagonists—in the setting of diabetic kidney disease (DKD) and their combined use. They perform a statistical analysis of clinical trials conducted to date and conclude that the current evidence is not strong for combination therapy. We consider it relevant to share additional information that must be considered when covering said topic. Evidence has revealed and emphasized that renal function trajectories in patients with diabetes differ.3Oshima M. Shimizu M. Yamanouchi et al.Trajectories of kidney function in diabetes: a clinicopathological update.Nat Rev Nephrol. 2021; 17: 740-750https://doi.org/10.1038/s41581-021-00462-yCrossref PubMed Scopus (7) Google Scholar,4Laranjinha I. Matias P. Mateus S. et al.Diabetic kidney disease: is there a non-albuminuric phenotype in type 2 diabetic patients?.Nefrología. 2016; 36: 503-509https://doi.org/10.1016/j.nefro.2016.03.025Crossref PubMed Scopus (0) Google Scholar Several phenotypes associated with DKD have been described. To date, 4 different phenotypes of DKD have been reported, the classic or albuminuric and 3 nonclassic phenotypes.3Oshima M. Shimizu M. Yamanouchi et al.Trajectories of kidney function in diabetes: a clinicopathological update.Nat Rev Nephrol. 2021; 17: 740-750https://doi.org/10.1038/s41581-021-00462-yCrossref PubMed Scopus (7) Google Scholar Although the classic DKD phenotype remains the most important, current evidence suggests that the nonclassic phenotypes are becoming common. Approximately 20% to 40% of DKD belong to the nonclassic phenotypes. Furthermore, cohort studies have suggested that renal and cardiovascular outcomes may vary between different DKD phenotypes. Therefore, it is necessary to classify and approach patients with DKD according to phenotype.3Oshima M. Shimizu M. Yamanouchi et al.Trajectories of kidney function in diabetes: a clinicopathological update.Nat Rev Nephrol. 2021; 17: 740-750https://doi.org/10.1038/s41581-021-00462-yCrossref PubMed Scopus (7) Google Scholar Important studies such as CREDENCE,S1 DAPA-CKD,S2 and FIDELIO-DKDS3 only include patients with a classic or albuminuric phenotype. The same happens with the combined therapy of SLGT2 inhibitor + mineralocorticoid receptor antagonists, which, although the current evidence is not solid for patients with DKD of the albuminuric phenotype, it is far less in patients with DKD of the nonalbuminuric phenotype. The first trial that will reveal evidence in patients with nonalbuminuric phenotype DKD is EMPA-KIDNEY (The Study of Heart and Kidney Protection With Empagliflozin).S4 We make a call not to generalize the patient with DKD, but to classify it according to its phenotype and from this approach guide the design of new clinical trials, build solid evidence, and achieve a positive impact on the management of these patients. Phenotype in the patient with DKD is important. All the authors declared no competing interests. Download .docx (.01 MB) Help with docx files Supplementary File (Word) Supplementary References. Moderating Effects in Randomized Trials—Interpreting the P Value, Confidence Intervals, and Hazard RatiosKidney International ReportsVol. 7Issue 3PreviewThe discovery of blood pressure lowering in the 1980s and the use of angiotensin-receptor blockers in the early 2000s were significant advances in protecting the kidney and the cardiovascular system from the ravages of type 2 diabetes. For nearly 2 decades, multiple interventions failed, including the use of combination renin-angiotensin system–blocking drugs. Full-Text PDF Open AccessThe Kidney Protective Effects of the Sodium–Glucose Cotransporter-2 Inhibitor, Dapagliflozin, Are Present in Patients With CKD Treated With Mineralocorticoid Receptor AntagonistsKidney International ReportsVol. 7Issue 3PreviewMineralocorticoid receptor antagonists (MRAs) and sodium–glucose cotransporter-2 (SGLT2) inhibitors reduce the risk of kidney failure in chronic kidney disease (CKD). We performed an analysis of the Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease (DAPA-CKD) trial by baseline conventional MRA (spironolactone and eplerenone) prescription. Full-Text PDF Open Access