For many years, the only specific pharmacologic intervention to decrease end-stage kidney disease in diabetic kidney disease was renin-angiotensin-aldosterone system blockade. Recently, sodium/glucose cotransporter 2 inhibitors, nonsteroidal mineralocorticoid antagonists, and glucagon-like peptide 1 receptor agonists have been introduced. However, there remains a need for new therapies. The nonspecific phosphodiesterase inhibitor pentoxifylline (PTX) has been shown to have antiproteinuric and anti-inflammatory effects, and small randomized clinical trials and meta-analyses indicate that PTX may have therapeutic benefits in diabetic kidney disease.