Dyslipidemias in patients who have chronic kidney disease

Patients with CKD are at high risk for developing CVD. In fact, most CKD patients have a 10-year risk of coronary heart disease events greater than or equal to 20%, placing them in the highest risk category according to the National Cholesterol Education Program Adult Treatment Panel III guidelines. For this reason, the National Kidney Foundation K/DOQI guidelines for managing dyslipidemia suggest that CKD patients with LDL greater than or equal to 100 mg/dL (2.59 mmol/L) should be treated with diet and a statin. The K/DOQI guidelines also make it clear that the evidence supporting treatment in CKD populations is lacking however, and that additional placebo-controlled trials are needed. In the mean time, the high incidence of CVD makes intensive monitoring and treatment of dyslipidemias in patients with CKD a reasonable clinical approach.     

Considerations for optimal iron use for anemia due to chronic kidney disease.

BACKGROUND: Availability of recombinant human erythropoietin (rHuEPO) has improved the treatment of anemia due to chronic kidney disease (CKD). Iron deficiency is the most common cause of resistance to rHuEPO therapy, contributing to ineffective erythropoiesis and hematocrit/hemoglobin values below the recommended target range (33%-36%/11-12 g/dL). I.v. iron supplementation is necessary to meet increased iron demands from stimulation of erythropoiesis and chronic blood loss; however, questions remain as to the optimal supplementation strategy to maintain appropriate yet safe iron status. Treatment guidelines for anemia management have been developed through the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI). OBJECTIVE: This review presents the basis of need for the NKF-K/DOQI guidelines and includes detailed information concerning iron physiology, metabolism, iron preparations, and evaluation of iron status. METHODS: This review was based on a MEDLINE search and complemented by references from the NKF-K/DOQI guidelines (whose review extended beyond MEDLINE). References focusing on normal iron physiology and metabolism, alterations in iron physiology in patients with CKD, laboratory evaluation methods, and strategies for iron supplementation were obtained from MEDLINE and reviewed for content. RESULTS: Controversy over appropriate use of iron supplementation has led to disparity in accepted practice procedures. Oral iron (ferrous salts and polysaccharide iron complex) and i.v. iron preparations (iron dextran, sodium ferric gluconate, and iron sucrose) are available. Problems with oral iron supplementation include limited absorption and patient noncompliance. Although most available data on i.v. iron use in the United States are specific to iron dextran preparations, published information based on clinical use of sodium ferric gluconate and iron sucrose products has been promising. The use of chronic i.v. iron administration to sustain iron stores has been more widely accepted to prevent development of absolute and functional iron deficiency. CONCLUSIONS: Although iron therapy is commonly warranted in patients with CKD, questions remain as to the most favorable supplementation strategy to optimize therapy through improvements in hematocrits, efficient use of rHuEPO, and maintenance of appropriate and safe iron levels. Clinicians will need to devise strategies based on the compilation of information from clinical experience and the available literature. Clinical practice guidelines devised by the NKF-K/DOQI have provided a useful tool for the medical community using both these resources.     

Executing change in the management of chronic kidney disease: perspectives on guidelines and practice

In this era of escalating information, costly technology, and an increasing prevalence of chronic complex diseases in an aging population, a systematic approach to execute changes in the care of patients with kidney disease must be developed. Specifically, there is a need to facilitate the translation of research and clinical guidelines into the delivery of quality clinical care. At present in nephrology, there is some knowledge of disease processes, accumulating knowledge about risk factors for progression, and knowledge about how to best deliver care to those with a chronic disease. The current health care environment is not suited to either the care of chronic conditions or to prevention. Information technology should facilitate shared models of care delivery for chronic conditions and allow opportunities to add new knowledge and deliver good care to complex patient groups. To execute change in the management of patients with CKD, medical students, healthcare professionals, and established physicians need to be educated about the prevalence and consequences of CKD. These educational initiatives should be done in the context of cases or specific patients especially for established practitioners, and should be simplified to make analogies to familiar concepts. The concept that CKD is a risk factor for cardiovascular disease, and needs to be managed (as does diabetes and dyslipidemia), should be more clearly articulated. Basic and clinical research in kidney disease has been enhanced by discoveries in vascular biology, diabetes, and cardiology. Much of the clinical research has been limited, however, by lack of clear definition of CKD. The development of the new K/DOQI staging system that defines and classifies the severity of kidney disease may improve the execution of ongoing robust clinical trials. Incorporating this classification system into the clinical practice of all physicians by automatic laboratory reporting of estimates of GFR raises awareness and improves communication between all medical professionals. Collaborative management of CKD patients between different physicians and multidisciplinary teams, in conjunction with the ongoing investigation of treatments and treatment strategies by both clinician and researchers, may well lead to improved outcomes for patients with CKD. Executing change in the management of CKD requires an increased awareness on the part of all clinicians, including nephrologists, regarding the prevalence and importance of the problem of earlier stages of kidney disease. The systematic evaluation of all patients and incorporation of simplified definitions and classification systems should enhance the ability to improve the outcomes of patients with kidney disease irrespective of time of identification.     

Statin therapy in patients with chronic kidney disease: to use or not to use

Dyslipdemia is a common complication of chronic kidney disease (CKD) and contributes to high cardiovascular morbidity and mortality of CKD patients. Experimental studies have demonstrated that lipids induce glomerular and tubulointerstitial injury and that lipid-lowering treatments ameliorate renal injury. Therapy with statins not only has the potential to lower cardiovascular morbidity and mortality in patients with CKD but also to slow progression of renal disease. Whereas the guidelines for treatment of hyperlipidaemia in nonrenal patients are based on prospective, randomized, placebo-controlled mega-trials, such data are not available for CKD patients. This review outlines the limited information currently available on the effect of statins among patients with CKD and summarizes the ongoing randomized trials designed to address this question.     

Lipoprotein(a) in nephrological patients

In contrast to existing EAS/ESC guidelines on the management of lipid disorders, current recommendations from nephrological societies are very conservative and restrictive with respect to any escalation of lipid lowering/statin therapy. Furthermore, lipoprotein(a) (Lp(a)) – an established cardiovascular risk factor – has not even been mentioned. While a number of retrospective and prospective studies suggested that Lp(a) has relevant predictive value and might have – at least in stage-3 chronic kidney disease (CKD) – the same negative effects if draged along in non-CKD patients, there is no guidance on diagnostic or therapeutic procedures. The persistent lack of recognition automatically leads to therapeutic nihilism, which might pose a number of relatively young patients to a significantly increased risk for adverse cardiovascular events. Further evaluation of Lp(a) in CKD is very important to provide appropriate treatment to patients with high Lp(a) levels, even in the presence of CKD.     

血液透析患者肾性骨病单中心横断面研究

目的了解慢性肾衰竭血液透析患者骨代谢及骨病控制情况,并进行相关影响因素分析。方法对青岛大学医学院附属医院血液净化中心血液透析的113例患者肾性骨病指标进行调查,并与美国肾脏病基金会慢性透析患者骨代谢和骨病控制指南(简称"指南")进行比较,以观测其达标水平。分析其与年龄、性别、尿素清除指数(Kt/V)、体重指数(body mass index,BMI)、透析时间、肾功能、血压、血红蛋白(Hb)、超敏C反应蛋白(highsen sitivity C-reactive protein,hs-CRP)的相关性。结果113例患者中,有61例(54.0%)血清钙浓度、45例(39.8%)磷浓度、72例(63.7%)钙磷乘积、35例(31.0%)全段甲状旁腺素(iPTH)达到指南所要求的目标;但所有指标均达到要求目标仅有20例(17.7%)。钙磷代谢紊乱及继发性甲状旁腺功能亢进与年龄、性别、hs-CRP、Kt/V、透析时间不相关;血肌酐(Scr)、血红蛋白(Hb)、BMI、高血压≥140/90mmHg(1mmHg=0.133kPa)为其发生的危险因素,其中血肌酐、血红蛋白、高血压为其独立危险因素。结论多数血液透析患者骨代谢及骨病控制不佳,不能达到指南要求的目标。其发生与肌酐、血红蛋白、血压水平密切相关。     

Chronic kidney disease: evolving strategies for detection and management of impaired renal function

Nephrologists have long been concerned about late referral of patients with severe kidney disease, and resultant poor outcomes on dialysis. But there is an increasing realisation that mild to moderate chronic kidney disease is far more common than previously appreciated. Furthermore, the main consequence of chronic kidney disease is not progression to dialysis, but increased risk of cardiovascular disease. Chronic kidney disease is at least as common and important a risk factor for cardiovascular disease as diabetes mellitus. The MDRD formula is a well-validated formula to estimate glomerular filtration rate, which is now being widely implemented by clinical chemistry laboratories, and should increase the recognition of chronic kidney disease. The K/DOQI classification of chronic kidney disease has gained international acceptance and provides the structure to guide referral and management. This classification, and associated guidelines, also focus attention on areas where evidence is lacking, and which urgently require research. These current developments will substantially change and improve how chronic kidney disease is identified and managed.     

老年慢性肾脏病患者骨质疏松发生情况与危险因素

目的分析老年慢性肾脏病(CKD)患者并发骨质疏松症后骨密度(BMD)的改变及其与各种危险因素的相关性,为早期诊断、早期防治CKD并发骨质疏松症提供理论依据。方法年龄65岁以上非透析的CKD住院患者,根据2002年K/DOQI指南CKD的定义及分期系统分为CKD 1~2期组、CKD 3期组和CKD 4~5期组。记录临床特征,实验室检查指标,并行双能X线骨密度测量法测定腰椎及股骨BMD。根据受试者的BMD值将CKD患者分为骨质疏松组(OP组)和非骨质疏松组(非OP组),对比两组CKD患者的性别、年龄、体质量指数(BMI)、血清钙、磷及骨钙素之间的差异,分析其危险因素。结果老年CKD患者骨质疏松发生率高达30.4%,OP组与非OP组比较,女性比率大,BMI及维生素D水平低,血清降钙素水平高。两组间差异均有统计学意义(P0.05)。多因素分析,绝经后女性和低BMI是老年CKD患者骨质疏松的危险因素。结论老年CKD患者骨质疏松发生率高,其中,绝经后老年女性和低BMI的老年患者是发生骨质疏松的高危人群。     

Secondary hyperparathyroidism: review of the disease and its treatment

BACKGROUND: Most patients with chronic kidney disease (CKD) stage 5 develop secondary hyperparathyroidism (SHPT). SHPT is an adaptive response to CKD and its associated disruptions in the homeostatic control of serum phosphorus, calcium, and vitamin D. The poor control of mineral and parathyroid hormone (PTH) levels characteristic of SHPT is associated with serious clinical consequences. OBJECTIVE: This review discusses the pathophysiology and consequences of SHPT, as well as the efficacy and limitations of current treatment modalities. METHODS: Literature searches were conducted using the MEDLINE, EMBASE, and BIOSIS databases. Additional information was obtained from Internet web sites, textbooks, and nephrology congress abstracts. RESULTS: Patients with uncontrolled SHPT are at higher risk for cardiovascular morbidity and mortality, hospitalization, bone disease, vascular and soft-tissue calcification, and vascular access failure than patients whose mineral and PTH levels are well managed. New National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) targets for calcium, phosphorus, calcium-phosphorus product, and PTH control have recently been published with the aim of improving the management of mineral metabolism in CKD patients. Data from observational studies suggest that the majority of patients currently have PTH and mineral levels outside these target ranges. CONCLUSIONS: Given the inadequacies of current therapies, novel agents are being developed that may help improve the management of SHPT.     

320排 CT 冠状动脉造影显示冠状动脉斑块特征与慢性肾疾病分期的相关性研究

目的：评估320排冠状动脉CT造影（CCTA）动脉硬化斑块的特征与慢性肾疾病（chronic kidney disease,CKD）分期的相关性。方法研究纳入151例因可疑冠心病而接受320排CCTA检查的CKD患者,男69例,女82例,年龄18～55岁。根据美国国立肾脏基金会（National Kidney Foundation）的分期将CKD分为5期。比较不同分期CKD患者的冠状动脉粥样硬化斑块状况[有无斑块、斑块数、钙化斑块（CP）、单支病变、多支病变、非钙化斑块（NCP）、混合斑块（MP）和梗阻性狭窄]。结果 Pearson 回归分析显示无斑块与CKD分期呈负相关（r＝-0.282,P＝0.44＜0.05）;而存在斑块与CKD分期呈正相关（r＝0.282,P＝0.44＜0.05）。多支病变、斑块数以及CP百分率与CKD分期呈正相关（r＝0.916,0.839,0.819,P＜0.001）。NCP 百分率与 CKD 分期无相关性（r＝0.19,P＝0.089＞0.05）。MP 百分率与 CKD分期呈正相关（r＝0.313,P＜0.05）。梗阻性狭窄与CKD分期呈正相关（r＝0.875,P＜0.001）。结论 CKD分期与存在斑块、多支病变和斑块数、CP、MP以及梗阻性狭窄呈正相关。更晚的CKD分期预示着更广泛更严重的冠心病。     

The treatment of coronary artery disease in patients with chronic kidney disease

Premature cardiovascular disease is the largest cause of mortality, and a major cause of morbidity, in patients with chronic kidney disease (CKD). Patients with end-stage kidney disease (ESKD) are at extreme risk, but cardiovascular event rates are increased even in early CKD. There is little controlled trial evidence on which to base treatment, as most therapeutic trials have excluded CKD patients. Current treatment strategies are therefore based upon small prospective studies or retrospective analyses of controlled trials and registry data. It is thus unclear whether CKD patients benefit from modern secondary preventive treatments in the same manner as patients with normal renal function. There is a need for randomized trials to identify effective drugs to prevent and treat coronary artery disease in CKD. Revascularization by CABG in CKD has been widely reported in registry data to provide better results than medical treatment or angioplasty. Recent angioplasty data in patients with CKD, however, show improving results, and the risks of CABG in CKD remain high. It is not clear which revascularization technique has a better outcome in patients 'equally suitable' on angiographic criteria for either procedure. The high rate of late adverse cardiovascular events after both CABG and angioplasty accentuates the need for effective secondary preventive therapy disease in these high-risk patients.     

评价慢性肾脏病患者贫血治疗的血红蛋白靶目标值的临床研究

目的对比慢性肾脏病患者治疗贫血的不同血红蛋白靶目标值范围的治疗结果,评价其对于患者的影响及临床价值。方法根据入选及排除标准,选取172例慢性肾脏疾病(CKD)患者,按1∶1比例随机分入高靶目标值组和低靶目标值组,血红蛋白治疗目标值分别为(100~110)g/L和(110~130)g/L。给予患者促红细胞生成素及铁剂治疗使其血红蛋白达到目标值,并根据K/DOQI指南对患者进行除贫血治疗外的CKD"一体化"治疗。定期检测相关实验室指标和辅助检查,定期进行生活质量量表评分,建立数据库并应用统计软件对观察结果进行分析。结果两组患者的基线特征无统计学差异,中位随访时间15.3个月,两组患者肾功能下降和心血管事件联合终点发生无统计学差异,对两组患者进行生活质量评分,肾脏疾病症状、肾脏病对日常生活影响、肾脏病带来的心理负担、躯体健康评分及心理健康评分方面均无统计学差异,低靶目标值组患者每周平均少用促红细胞生成素1 470 IU,节约医疗花费877.45元。结论肾性贫血治疗的靶目标值设定为(100~110)g/L,在治疗的安全性和有效性方面和(110~130)g/L范围组相比并无显著差异,而在药物用量和经济性方面更具优势。     

江阴市脑出血住院患者慢性肾脏病发病情况调查

目的调查江阴市脑出血住院患者的慢性肾脏病（CKD）发病情况及危险因素。方法收集江阴市人民医院神经内科2007年1月至2009年12月间住院的1 430例脑出血患者的临床资料,其中资料完整者932例,男602例,女330例,平均年龄（63.8±12.0）岁。所有患者均分别经脑CT和（或）磁共振成像（MRI）确诊。观察肾脏损伤指标,包括血清肌酐（SCr）及尿常规和相关危险因素（血压、烟酒史、心脏病史、脑卒中部位、空腹血糖、血脂、凝血功能、血常规等）。采用简化的改良肾脏病膳食研究（MDRD）公式估算肾小球滤过率（GFR）,并根据肾脏疾病生存质量指导（K/DOQI）指南进行CKD分期。结果蛋白尿119例（12.8%）,血尿189例（20.3%）,SCr〉105μmol/L者39例（4.2%）,eGFR≤60 ml.min-1.（1.73 m2）-1者30例（3.2%）。CKD为251例,患病率为26.9%;CKD 1~5期分别占该人群的65.7%、22.3%、9.2%、1.6%与1.2%;本组病例中,年龄≥65岁者CKD患病率为27.3%,eGFR≤60 ml.min-1.（1.73 m2）-1的比例为3.8%。logistic回归分析脑梗死患者CKD危险因素为性别（OR=1.443,P〈0.05）、糖尿病（OR=1.637,P〈0.01）、饮酒（OR=0.673,P〈0.05）、高甘油三酯（OR=0.628,P〈0.05）、高尿酸（OR=2.730,P〈0.01）、低血红细胞比容（OR=1.985,P〈0.05）。结论江阴地区脑出血住院患者中CKD患病率26.9%,明显高于一般人群,应重视在脑出血患者中的CKD调查,早期预防和积极干预CKD,以改善患者预后。     

Obesity and coronary artery disease risk in Native Americans

With the aging of the US population and the increase in hypertension, diabetes mellitus, and obesity, the prevalence of chronic kidney disease (CKD) is increasing in the United States. Its prevalence rate has risen to 13.1% of the US population. Patients with CKD experience poor outcomes and have high health care costs. Chronic kidney disease is also a major cardiovascular disease risk factor. In fact, most people with CKD die of heart disease before they progress to end-stage renal disease. The National Kidney Foundation has produced evidencebased guidelines known as the Kidney Disease Outcomes Quality Initiative (KDOQI). These guidelines outline many things that the primary care physician can do to delay the progression of CKD, and to arrange for early referral for the prevention of future complications. However, there is limited knowledge and uptake of these guidelines because of their length and and complexity. Patients with CKD risk factors, hypertension, diabetes mellitus, cardiovascular disease, a family history of CKD, and those older than 60 years should be screened using 2 tests: 1) the estimated glomerular filtration rate and 2) the urinary albumin-creatinine ratio. These tests allow the diagnosis and stratification of CKD into 5 stages. This article synthesizes the key evidence-based behaviors and clinical action plan that primary care physicians can implement to treat CKD and its complications.     

Diagnostic challenges of kidney diseases in HIV-infected patients

Introduction: Chronic kidney disease (CKD) is a prevalent comorbidity in persons living with HIV infection (PLWH) associated with an increase in cardiovascular morbidity and all-cause mortality. Furthermore, early diagnosis of CKD is difficult in PLWH.

Areas covered: We reviewed the main diagnostic tools for CKD in PLWH, and discussed their strengths and limits. We performed a literature search on PubMed to identify reviews and clinical trials dealing with attractive kidney biomarkers of CKD in PLWH, with the following key words: ‘HIV AND kidney’, ‘HIV AND Kidney biomarkers’, ‘CKD AND Kidney biomarkers’.

Expert commentary: Currently, CKD diagnosis is based on the estimation of Glomerular Filtration Rate (GFR), and measurement of proteinuria by urine protein/creatinine ratio (uPCR). These parameters are independent and complementary predictors of outcomes. GFR estimates are lacking in accuracy in PLWH. The best GFR estimate is CKD-EPI study equation. Moreover, low-grade proteinuria is associated with an increased risk of kidney disease progression in PLWH, and guidelines derived from the general population may lack sensitivity. Different biomarkers of kidney diseases like N-acetyl beta glucosaminidase (NAG), Kidney Injury Molecule-1 (KIM-1), and Alpha-1-microglobulin may predict kidney disease progression and mortality in PLWH. Others may help clinicians detect antiretroviral-induced tubulopathy, or predict cardiovascular events. More studies are needed to validate the routine use of these types of biomarkers.     

Effects of statins on renal function

Patients with chronic kidney disease (CKD) are much more likely to die of cardiovascular disease than end-stage renal disease. Dyslipidemia is highly prevalent in patients with CKD and may contribute to the elevated cardiovascular risk as well as CKD progression. Statins are lipid-lowering drugs that appear to protect the kidneys via cholesterol reduction as well as noncholesterol-mediated mechanisms. Subgroup analyses of major clinical studies and meta-analyses of smaller trials indicate that statin therapy slows the decline of the glomerular filtration rate. Additionally, statins appear to reduce proteinuria in patients with CKD. Statins are well recognized to reduce cardiovascular morbidity and mortality in patients with and without documented cardiovascular disease and in certain high-risk populations, such as persons with diabetes mellitus. However, conclusive evidence for improved cardiovascular outcomes with statin therapy for CKD is not yet available. Several ongoing studies are evaluating the effect of statins on cardiovascular end points in patients with CKD and may provide data needed to support adjunctive use of these agents in this high-risk population.     

Control of blood pressure in chronic kidney disease: how low to go?

Blood pressure (BP) lowering is an important therapeutic goal in patients with diabetic and non-diabetic chronic kidney disease (CKD) for slowing progression and preventing onset of cardiovascular disease. The guidelines for treatment of hypertension in patients with CKD recommend a target BP <130/80 mm Hg, with no clear threshold on the lower limit. However, results of recent randomized controlled trials on CKD indicate that aggressive lowering of BP may not provide additional benefit in the vast majority of patients. This paper will review the literature on the main trials examining the question concerning the optimal level of target BP in patients with CKD and also discuss reasonable target BP levels in light of the evidence, as well as future direction for research in such patients.     

Management of renal osteodystrophy in peritoneal dialysis patients.

The term "renal osteodystrophy" encompasses all forms of metabolic bone disease found in dialysis patients. The primary approach to the treatment of renal osteodystrophy in peritoneal dialysis (PD) patients is similar to that in hemodialysis patients. However, the increased prevalence of adynamic bone histology, together with the difficulty in judging calcium balance, the inability to practicably give intravenous vitamin D, and the clearance of vitamin D and parathyroid hormone via dialysate require a different therapeutic approach in PD compared to hemodialysis patients. Clearly, more comparative studies of new agents are needed to find the optimal approach to achieving the K/DOQI guidelines in PD patients. The unique aspects of the approach to renal osteodystrophy in PD patients are the focus of this review.     

慢性肾脏病血B型利钠肽水平与心脏结构及功能的关系

目的探讨慢性肾脏病（CKD）非透析患者血B型利钠肽水平（BNP）与心脏结构及功能的关系。方法选取96例CKD3～5期非透析患者为研究对象,另选20例年龄、性别匹配的健康体检者为对照;清晨空腹取血检测BNP,并行超声心动图检查。结果与对照组相比,CKD各期血BNP浓度均增高（P均〈0．01）;且随着CKD进展,BNP水平呈逐渐增加趋势;相关分析显示血BNP浓度与左心室心肌质量指数（LMVI）（r=0．502,P〈0．01）及左心室舒张末内径（LVEDd）（r=0．384,P〈0．01）呈正相关,与心脏射血分数（EF）呈负相关（r=-0．593,P〈0．01）。结论CKD患者血BNP浓度随CKD进展而升高,BNP水平对CKD患者心室结构改变及EF下降有预测价值。     

Glycemic control of type 2 diabetes mellitus across stages of renal impairment: information for primary care providers

Chronic kidney disease (CKD) is a frequent complication of type 2 diabetes mellitus (T2DM) and elevates individuals’ risk for cardiovascular disease, the leading cause of morbidity and mortality in T2DM. Achieving and maintaining tight glycemic control is key to preventing development or progression of CKD; however, improving glycemic control may be limited by effects of renal impairment on the efficacy and safety of T2DM treatments, necessitating dosing adjustments and careful evaluation of contraindications. Understanding the treatment considerations specific to each class of T2DM medication is important in individualizing therapy and improving glycemic, renal, and cardiovascular outcomes.

Traditional glucose-lowering treatments include insulin, metformin, sulfonylureas, meglitinides, and thiazolidinediones. Each of these agents exhibits altered pharmacokinetics in patients with renal impairment except for the thiazolidinediones, which are metabolized by the liver and do not accumulate appreciably in patients with renal impairment. Newer glucose-lowering treatments include GLP-1 receptor agonists, DPP-4 inhibitors, and SGLT2 inhibitors. Of these, only the DPP-4 inhibitor linagliptin can be used across all stages of renal impairment without dosing restrictions or concerns regarding dose escalation, and all SGLT2 inhibitors are contraindicated when eGFR <45 mL/min/1.73m². Several of the newer treatments have also been investigated for effects on renal and cardiovascular outcomes, demonstrating potential benefits of the GLP-1 agonists liraglutide and semaglutide, as well as the SGLT2 inhibitors canagliflozin and empagliflozin, in reducing risk for some adverse renal and cardiovascular events. In addition, some DPP-4 inhibitors have been shown to reduce albuminuria, an indicator of glomerular dysfunction. Consideration of this information is useful in informing optimal management strategies for patients with T2DM and concomitant CKD. More clinical data from future and ongoing clinical trials, including data regarding potential renal and cardiovascular benefits, will be important in clarifying the safety and efficacy profiles of each of these agents in patients with CKD.