Kidney Care in Diabetes

 

Diabetic kidney disease (DKD) Around 40% of diabetes patients develop DKD which is the major cause of ESRD. DKD is a major but less recognized contributor to the global burden of disease. There is a 94% rise in deaths of DKD between 1990 and 2012. Most of the excess risk of cardiovascular disease (CVD) mortality for patients with diabetes is related to DKD.

Metabolic changes in diabetes lead to glomerular hypertrophy, glomerulosclerosis, and tubulointerstitial inflammation and fibrosis. Despite current therapies, the risk of diabetic kidney disease onset and progression kept on increasing. The development of therapeutic agents targeting kidney-specific disease mechanisms (e.g., glomerular hyperfiltration, inflammation, and fibrosis) is urgently needed to improve health outcomes for patients with diabetic kidney disease.

Risk Factors

Advancing age with a family history of DKD and, high protein intake are the major risk factors for DKD. Males were found to have DKD more than their female counterparts. Uncontrolled diabetes, obesity, and hypertension also contribute to the same

Act before it’s too late

Prevention of diabetic complications, by long-term intensive glycemic control from early during diabetes, is a well-established approach in the management of DKD. Intensive glucose control after the onset of complications or in longstanding diabetes has not been shown to reduce the risk of DKD progression.

The American Diabetes Association recommends more stringent goals, such as HbA1C<6.5%, which might be helpful to patients with a shorter duration of diabetes, younger age, absence of complications, and a longer life expectancy.

Treatment for diabetic kidney disease includes controlling blood pressure and blood sugar levels and reducing dietary protein intake.

Intensive blood pressure lowering is recommended in patients with DKD it may prevent end-stage kidney disease (ESKD) in patients with severely increased albuminuria. An angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) helps manage DKD. Combination antihypertensive therapy will be required for most individuals with DKD.

As high protein intake is a risk factor for DKD, lowering protein in the diet may cause malnutrition. In such cases, alpha keto-analogs can be used.

Population-Based Approaches

Systematic implementation of guidelines for the treatment of hypertension and diabetes, regular albuminuria testing, use of ACE inhibitors and ARBs, and services to support nutrition, physical activity, and diabetes education has shown a 54% decrease in diabetes-related kidney failure occurred between the years 1996 and 2013 among American Indians.

Using public health and population approaches and promoting meaningful and strategic research will be key to improving health outcomes for people with diabetes and DKD.