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Diabetes: how to manage chronic kidney disease
BACKGROUND: Chronic kidney disease (CKD) is a prevalent and progressive condition worldwide, and diabetes is a leading risk factor of this renal disorder. People with diabetes and CKD are at high risk of complications such as cardiovascular events and death. CKD is often unrecognized and undiagnosed...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioExcel Publishing Ltd
2022
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9205574/ https://www.ncbi.nlm.nih.gov/pubmed/35775073 http://dx.doi.org/10.7573/dic.2021-9-10 |
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author | Clements, Jennifer N |
author_facet | Clements, Jennifer N |
author_sort | Clements, Jennifer N |
collection | PubMed |
description | BACKGROUND: Chronic kidney disease (CKD) is a prevalent and progressive condition worldwide, and diabetes is a leading risk factor of this renal disorder. People with diabetes and CKD are at high risk of complications such as cardiovascular events and death. CKD is often unrecognized and undiagnosed amongst people with diabetes. To manage CKD, multiple existing and newer agents have been studied in trials and recommended in clinical practice guidelines. METHODS: A narrative review of primary and/or secondary renal outcomes from randomized, controlled trials is summarized in this article. The main objective was to provide the most up-to-date information regarding existing and new pharmacotherapy for the management of CKD amongst people with diabetes, specifically type 2 diabetes (T2D). 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 approval by the FDA for the management of CKD such as dapagliflozin, with a role in reducing intraglomerular pressure. Evidence with sodium–glucose cotransporter 2 inhibitors show a potential class effect on improving renal outcomes, independent on their effect on glycaemic parameters. Recently, finerenone was approved for people with T2D and CKD based on clinical evidence as a non-steroidal mineralocorticoid receptor antagonist. Overall, 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 management and achievement of glycaemic targets for people with diabetes and CKD, following adequate screening of glomerular filtration rate and/or severity of albuminuria. CONCLUSION: Due to more robust evidence, clinical practice guidelines have been modified to reflect high-level recommendations for the management of CKD in people with diabetes, specifically T2D. Additional evidence is needed amongst people with lower glomerular filtration rates and in comparison with the standard of care. |
format | Online Article Text |
id | pubmed-9205574 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioExcel Publishing Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-92055742022-06-29 Diabetes: how to manage chronic kidney disease Clements, Jennifer N Drugs Context Review BACKGROUND: Chronic kidney disease (CKD) is a prevalent and progressive condition worldwide, and diabetes is a leading risk factor of this renal disorder. People with diabetes and CKD are at high risk of complications such as cardiovascular events and death. CKD is often unrecognized and undiagnosed amongst people with diabetes. To manage CKD, multiple existing and newer agents have been studied in trials and recommended in clinical practice guidelines. METHODS: A narrative review of primary and/or secondary renal outcomes from randomized, controlled trials is summarized in this article. The main objective was to provide the most up-to-date information regarding existing and new pharmacotherapy for the management of CKD amongst people with diabetes, specifically type 2 diabetes (T2D). 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 approval by the FDA for the management of CKD such as dapagliflozin, with a role in reducing intraglomerular pressure. Evidence with sodium–glucose cotransporter 2 inhibitors show a potential class effect on improving renal outcomes, independent on their effect on glycaemic parameters. Recently, finerenone was approved for people with T2D and CKD based on clinical evidence as a non-steroidal mineralocorticoid receptor antagonist. Overall, 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 management and achievement of glycaemic targets for people with diabetes and CKD, following adequate screening of glomerular filtration rate and/or severity of albuminuria. CONCLUSION: Due to more robust evidence, clinical practice guidelines have been modified to reflect high-level recommendations for the management of CKD in people with diabetes, specifically T2D. Additional evidence is needed amongst people with lower glomerular filtration rates and in comparison with the standard of care. BioExcel Publishing Ltd 2022-07-01 /pmc/articles/PMC9205574/ /pubmed/35775073 http://dx.doi.org/10.7573/dic.2021-9-10 Text en Copyright © 2022 Clements JN https://creativecommons.org/licenses/by-nc-nd/4.0/Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission. |
spellingShingle | Review Clements, Jennifer N Diabetes: how to manage chronic kidney disease |
title | Diabetes: how to manage chronic kidney disease |
title_full | Diabetes: how to manage chronic kidney disease |
title_fullStr | Diabetes: how to manage chronic kidney disease |
title_full_unstemmed | Diabetes: how to manage chronic kidney disease |
title_short | Diabetes: how to manage chronic kidney disease |
title_sort | diabetes: how to manage chronic kidney disease |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9205574/ https://www.ncbi.nlm.nih.gov/pubmed/35775073 http://dx.doi.org/10.7573/dic.2021-9-10 |
work_keys_str_mv | AT clementsjennifern diabeteshowtomanagechronickidneydisease |