Diabetes and chronic kidney disease

Diabetes is leading cause of end-stage renal disease accounting for 45% of new cases of kidney failure in the US.

Diabetic kidney disease is characterized by albuminuria, lowered GFR, as the manifestations of kidney disease.

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.

Women with diabetes have higher mortality rates with diabetes-related deaths, a higher prevalence of diabetic kidney disease risk factors such as hypertension, hyper glycemia, 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.

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.

The use of a Sodium-glucose cotransporter 2 (SGLT2) inhibitor improves the outlook of chronic kidney disease.
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.

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