Pentoxifylline in Diabetic Kidney Disease

Inclusion Criteria: 1. Type-2 diabetes. 2. Meet one of the following categories at a time that is greater than 90 days prior to randomization: * Group I: eGFR 15 to less than 30 mL/min/1.73 m2 regardless of the degree of albuminuria/proteinuria, or * Group II: eGFR 30 to less than 45 mL/min/1.73 m2 with UACR greater than or equal to (\>) 30 mg/g or UPCR greater than or equal to (\>) 150 mg/g, or * Group III: eGFR 45 to less than 60 mL/min/1.73 m2 with UACR greater than or equal to (\>) 300 mg/g or UPCR greater than or equal to (\>)500 mg/g 3. Participants need to be in one of the following categories at the time of randomization: * Group I: eGFR 15 to less than 30 mL/min/1.73 m2, or * Group II: eGFR 30 to less than 45 mL/min/1.73 m2 with UACR greater than or equal to (\>) 30 mg/g, or * Group III: eGFR 45 to less than 60 mL/min/1.73 m2 with UACR greater than or equal to (\>) 300 mg/g Participants must be a United States Veteran, currently receiving care at a VA hospital with a local study team. Exclusion Criteria: 1. Type 1 diabetes 2. History of non-diabetic kidney disease 3. Severe comorbid conditions expected to reduce life expectancy to less than 1 year, as determined by LSI 4. Active substance abuse, homelessness, or other condition that is likely to result in participant non,ompliance as determined by the LSI 5. Previous organ or bone marrow transplant 6. Pregnancy, breast feeding or female of child-bearing potential unwilling to use a reliable form of contraception 7. A recent (within 3 months) cerebral hemorrhage 8. Current use of oral pentoxifylline 9. Hypersensitivity to pentoxifylline or any of the components of the formulation 10. Current use of systemic ketorolac, oral or IV (contraindicated with pentoxifylline) 11. Current use of riociguat (contraindicated with pentoxifylline) 12. Current use of dialysis 13. Unable to provide informed consent 14. or any condition that in the opinion of the LSI would make the potential participant non-compliant