Diabetic kidney disease: a clinical update from Kidney Disease: Improving Global Outcomes

Abstract

The incidence and prevalence of diabetes mellitus (DM) continue to grow markedly throughout the world, due primarily to the increase in type 2 DM (T2DM). Although improvements in DM and hypertension management have reduced the proportion of diabetic individuals who develop chronic kidney disease (CKD) and progress to end-stage renal disease (ESRD), the sheer increase in people developing DM will have a major impact on dialysis and transplant needs. This KDIGO conference addressed a number of controversial areas in the management of DM patients with CKD, including aspects of screening for CKD with measurements of albuminuria and estimated glomerular filtration rate (eGFR); defining treatment outcomes; glycemic management in both those developing CKD and those with ESRD; hypertension goals and management, including blockers of the renin-angiotensin-aldosterone system; and lipid management.

Figure 1

Approaches to improving outcomes related to diabetic kidney disease. The best approach to prevent diabetic kidney disease is to prevent the diabetes itself. However, once diabetes occurs glycemic control may prevent/delay the development of diabetic kidney disease. In those patient who develop diabetic kidney disease, glycemic control, blood pressure control, and RAAS inhibition are all important in delaying/decreasing progression to ESRD and glycemic control, blood pressure control, and lipid management are all important in delaying/decreasing the development of CVD. CVD, cardiovascular disease; ESRD, end-stage renal disease; RAAS, renin-angiotensin-aldosterone system. White arrows denote potential preventive measures.