Abstract Diabetic kidney disease (DKD) is one of the common complications of diabetes mellitus, which usually progresses to end‐stage renal disease and causes great damage to the health of patients. Endothelin‐1 (ET‐1), a molecule closely associated with the progression of DKD, has increased expression in response to high glucose stimulation and is involved in hemodynamic changes, inflammation, glomerular and tubular dysfunction in the kidney, causing an increase in proteinuria and a decrease in glomerular filtration function, ultimately leading to glomerulosclerosis and renal failure. This paper aims to review the molecular level changes, regulatory mechanisms, and mechanisms of action of ET‐1 under DKD, clinical trials of ET‐1 receptor antagonists in recent years and current problems, to provide basic information and new research directions and ideas for the treatment of DKD and ET‐1‐related research.
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