Chronic kidney disease in type 2 diabetes: Implications for managing glycaemic control,cardiovascular and renal risk |
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| Authors: | Jeffrey W. Stephens FRCP Karen E. Brown MRCP Thinzar Min FRCP |
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| Affiliation: | Diabetes Research Group, Swansea University Medical School, Swansea University, Swansea, UK |
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| Abstract: | This review examines the current literature relating to diabetes related kidney disease (DKD) and the optimal management of cardio-renal risk. DKD develops in approximately 40% of patients with type 2 diabetes mellitus. The mainstay of therapy is to reduce the progression of DKD by optimising hyperglycaemia, blood pressure, lipids and lifestyle. Evidence supports the role for renin-angiotensin system blockade in limiting the progression of DKD. Recent data from diabetes related cardiovascular outcome trials and renal specific trials have provided a novel insight on the additional benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in reducing the progression of DKD as well as cardiovascular risk. Lessons have been learnt from CREDENCE and there are expectations that DAPA-CKD and EMPA-KIDNEY will further support the benefits of SGLT2 inhibition in relation to DKD. As a consequence, international guidelines have been updated to reflect the positive benefits. In addition, novel steroidal mineralocorticoid receptor antagonists offer a potential role in future years. The review examines the current evidence and future approach to optimising outcomes for renal protection in patients with diabetes. |
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| Keywords: | angiotensin II receptor blockers angiotensin-converting enzyme inhibitors chronic kidney disease diabetes-related nephropathy diabetic nephropathy dipeptidyl peptidase-4 (DPP-4) inhibitors glucagon like peptide-1 receptor agonists sodium-glucose cotransporter-2 inhibitors type 2 diabetes |
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