Journal of Clinical & Experimental Nephrology

Diabetes and Chronic Kidney Disease, Joint Management of 2 Associated Conditions and their Complex Interaction, Review of the Literature

Background: Chronic Kidney Disease (CKD) is a prevalent and progressive condition worldwide and diabetes is a major risk factor for this kidney disorder. People with diabetes and CKD are at high risk of complications, such as cardiovascular events and death. CKD is often unrecognized and undiagnosed among people with diabetes. To control CKD, multiple existing and newer agents have been studied in trials and recommended in clinical practice guidelines.

Methods: This article summarizes a narrative review of primary and/or secondary renal outcomes from randomized controlled trials. The main objective was to provide the most up-to-date information on new and existing pharmacotherapy for the treatment of CKD among people with diabetes, specifically type 2 diabetes (DM2).

Discussion: Traditional agents, such as angiotensin converting enzyme inhibitors and angiotensin receptor blockers, have been used for 20 years to preserve kidney function. Other existing agents have received FDA approval for the treatment of CKD, such as dapagliflozin, with a role in reducing intraglomerular pressure. Evidence with sodiumglucose cotransporter 2 inhibitors shows a possible class effect in improving renal outcomes, independent of their effect on glycemic parameters. Finerenone was recently approved for people with DM2 and CKD based on clinical evidence as an antagonist of non-steroidal mineralocorticoid receptors. In general, primary and secondary prevention trials have influenced changes in clinical practice guidelines regarding the use of existing and new pharmacotherapy for CKD. Additional considerations include lifestyle modifications, blood pressure control and achievement of glycemic goals for people with diabetes and CKD, following appropriate screening for glomerular filtration rate and/or albuminuria severity.

Conclusion: Due to stronger evidence, clinical practice guidelines have been modified to reflect high-level recommendations for the management of CKD in people with diabetes, specifically DM2. Further evidence is needed among people with lower glomerular filtration rates and in comparison with standard of care.

Author(s): Juan Sebastian Theran Leon

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