In the USA, over 12 million individuals have diabetic kidney disease (DKD) and 38% of end-stage kidney disease (ESKD) is caused by diabetes.1–3 There is longstanding evidence supporting use of renin and angiotensin system inhibitors (RAASi) to slow the progression of DKD to ESKD.4–6 More recently, sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated reduction of ESKD or death due to CKD in patients with diabetes.7–11 However, studies for patients with DKD reveal care gaps for both RAASi and SGLT2i prescriptions.12–16. The gene discussed is REN; the disease is diabetic kidney disease.