Diagnosis 101: diabetic kidney disease

Chronic kidney disease (CKD) attributed to diabetes occurs in 20%–40% of patients with diabetes mellitus. Diabetic kidney disease (DKD) is recognized as the most common cause of end-stage kidney disease in the USA and most Western countries. For quite some time, it has been recognized that treatments based on inhibition of the renin-angiotensin system (RAS) can reduce the rates of cardiovascular morbidity and mortality in patients with DKD. Recently however, several novel agents, namely sodium-glucose co-transporter 2 inhibitors, dipeptidyl peptidase 4 inhibitors and glucagon-like peptide-1 receptor agonists, were demonstrated to not only improve glycemic control but also to improve cardiovascular and renal outcomes. Another agent, a nonsteroidal mineralocorticoid antagonist, has also been shown to have cardiorenal benefits in patients with DKD. With such new developments, one would expect that it would eventually translate into further slowing CKD progression in the DKD population, provided that patients are diagnosed appropriately and in a timely manner. In this study, the authors attempt to investigate real-world data, looking at how well providers are establishing the diagnosis of DKD and its potential implications.