Ian H. de Boer, a nephrology expert from the University of Washington, discusses the critical link between chronic kidney disease (CKD) and diabetes. He reveals that 30-40% of diabetic patients develop CKD and emphasizes innovative prevention strategies, including lifestyle changes and screening tests like eGFR. The conversation also covers groundbreaking treatments such as SGLT2 inhibitors and finerenone, showcasing their potential to significantly reduce CKD progression and enhance patient outcomes. Don't miss these vital insights!
Chronic kidney disease affects 30% to 40% of diabetes patients, highlighting the importance of annual monitoring for eGFR and albuminuria.
Management strategies for CKD in diabetes now include innovative pharmacologic options like SGLT2 inhibitors and GLP-1 receptor agonists.
Deep dives
Understanding Chronic Kidney Disease (CKD) and Diabetes
Chronic kidney disease (CKD) is a prevalent condition among individuals with diabetes, marked primarily by reduced estimated glomerular filtration rate (eGFR) and elevated albuminuria. It is estimated that about one-third of diabetes patients experience CKD, and persistent abnormalities in eGFR or albuminuria are vital criteria for diagnosis. The discussion highlights the significance of consistent monitoring and screening for CKD, recommending that patients undergo annual assessments of eGFR and albuminuria, especially after a diabetes diagnosis. Understanding the epidemiology of CKD enables healthcare providers to identify those at risk and implement appropriate management strategies.
Prevention Strategies for CKD in Diabetic Patients
Effective management of diabetes is crucial for preventing the onset and progression of CKD, with glycemic control being a primary focus. Longitudinal studies have shown that individuals who maintain tight glycemic control, especially early in their diabetes journey, experience a significantly reduced risk of developing CKD. Additionally, adopting cardiovascular health measures such as engaging in regular physical activity, maintaining a healthy weight, and following a diet low in sodium can further decrease the risk. These lifestyle modifications, along with proper medication management, play a pivotal role in safeguarding kidney health in diabetic patients.
Advancements in Pharmacologic Treatments for CKD
Recent advances in pharmacologic therapies have revolutionized the management of CKD in diabetic patients, moving beyond traditional renin-angiotensin system inhibitors to include newer classes of medications. SGLT2 inhibitors and GLP-1 receptor agonists have emerged as significant options, demonstrating substantial efficacy in reducing the risks associated with CKD progression and cardiovascular events. Clinical trials indicate that these medications can confer benefits irrespective of baseline glycemia, making them suitable for a broad range of patients with type 2 diabetes. Additionally, the non-steroidal mineralocorticoid receptor antagonist, finerenone, offers an alternative treatment for those with residual albuminuria despite other therapies, thus providing clinicians with a comprehensive toolkit for managing CKD.
Chronic kidney disease develops among 30% to 40% of people with type 1 or type 2 diabetes during their lifetime. Author Ian H. de Boer, MD, MS, of the University of Washington Division of Nephrology, discusses the evaluation and treatment of chronic kidney disease in patients with type 1 and type 2 diabetes with JAMA Senior Editor Karen Lasser, MD, MPH. Related Content: