Diabetes is leading cause of end-stage renal disease accounting for 45% of new cases of kidney failure in the US.
Chronic kidney disease defined as an estimated GFR of less than 60 mL/per minute per 1.73 m² and/or urine albumin to creatinine ratio greater than or equal to 30 mg/ gram for at least three months and develops among 30 to 40% of people with type 1 or type 2 diabetes during their lifetime.
Diabetic kidney disease is characterized by albuminuria, lowered GFR, as the manifestations of kidney disease.
Chronic kidney disease can progress to kidney failure, requiring dialysis or kidney transplant and associated with cardiovascular disease and premature mortality.
The prevalence of kidney disease in patients with diabetes is estimated to be between 25 and 40%.
Patients with diabetic kidney disease and more likely to die from cardiovascular causes them from progression to end-stage renal disease.
Diabetic kidney disease is a marker for increased cardiovascular risk and is also involved in the pathogenesis of cardiovascular disease.
Traditional risk factors such as hypertension, hyperlipidemia, and obesity do not fully explain the worse cardiovascular mortality outcomes in diabetic kidney disease.
More than 1/4 of individuals with chronic kidney disease have type two diabetes.
Risk factors for CKD include higher hemoglobin A1c, and hypertension,
Women with diabetes have higher mortality rates with diabetes-related deaths, a higher prevalence of diabetic kidney disease risk factors such as hypertension, hyperglycemia, obesity, and dyslipidemia.
Renal impairment is detectable in approximately one third of patients with type two diabetes at some time during the course of the disease, and is associated with excessive cardiovascular morbidity and mortality.
All patients with diabetes should have an annual serum creatinine level.
Patients with chronic kidney disease and type two diabetes have increased risk for chronic kidney disease progression, insulin resistance and hyperglycemia, hypoglycemia and cardiovascular morbidity and mortality compared with individuals with type two diabetes who do not have chronic kidney disease.
In the first two stages of kidney improved blood pressure control, improved glycemia, reduced use of nonsteroidal anti-inflammatory drugs and frequent screening for albuminuria are indicated.
The only currently approved treatment for renal protection in patients with type two diabetes is renin-angiotensin system blockade.
Treatment of patients with diabetes, and CKD should involve lifestyle, modifications and medications to reduce the risk of disease, progression and cardiovascular events.
Lifestyle modifications include a healthy, low salt diet, at least 150 minutes per week of exercise, smoking cessation, weight management, and pharmacological therapies are based on evidence from randomized trials and are guided by CKD stage and presents of albuminuria.
Patients with diabetes and reduced kidney function persisting with monotherapy, treatment with metformin compared with a sulfonylurea is associated with a lower risk of major adverse cardiac events.
In patients with CKD and type two diabetes, treatment with finerenone results in lower risk of chronic kidney disease progression and cardiovascular events than placebo.
GLP-1 receptor agonists reduces the risk of clinically important kidney outcomes, and death from cardiovascular causes in patients with type two diabetes and chronic kidney disease.
Renin-angiotensin inhibitors-angiotensin converting enzyme, inhibitors or angiotensin II receptor blockers are effective antihypertensive medications that reduce risk of CKD progression and cardiovascular disease with type one or type two diabetes who have hypertension and albuminuria.
Sodium glucose co-transporter 2 inhibitors are first line therapy for people with type two diabetes and CKD even when the goal hemoglobin A1c is met: they decrease kidney disease progression events, and lower rates of cardiovascular death or heart failure hospitalization events compared with placebo.