Chronic kidney disease in the context of diabetes mellitus
Authors:
Anna Török Zapletalová 1,2; Mariana Rončáková 1,2; Emil Martinka 1; Peter Galajda 2
Authors‘ workplace:
Diabetologické oddelenie NEDÚ n. o., Ľubochňa
1; Jesseniova LF UK a UNM, Martin
2
Published in:
Forum Diab 2024; 13(2): 59-61
Category:
Review Article
Overview
Chronic kidney disease develops in almost 20–40 % of patients with diabetes. Diabetes mellitus is the leading cause of chronic kidney disease in dialysis patients. The diabetologist has a key role in diagnosis, influencing its progression and the transition to the stage of kidney failure. A patient with confirmed diabetic kidney disease has a very high cardiovascular and sudden death risk. The management of the treatment of a diabetic patient with developed renal complications should therefore be comprehensive in order to influence individual cardiovascular risk factors. A holistic approach is also preferred by the consensus of the ADA (American Diabetes Association) and KDIGO (Kidney Disease: Improving Global Outcomes) from 2022. Adjustment of lifestyle interventions, treatment of arterial hypertension, dyslipidemia and adjustment of glycemic compensation form the basic pillars of management and are the competence of the diabetologist. SGLT2-inhibitors (SGLT2i), GLP1-receptor agonists (GLP1-RA) and metformin are the preferred groups in the treatment of type 2 diabetes mellitus. Dipeptidyl peptidase 4 inhibitors, sulfonylurea derivatives and insulin therapy are considered as complementary drugs. In the case of type 1 diabetes mellitus, insulin therapy remains the only possible option. New groups of antidiabetics (SGLT2i, GLP1-RA) have a proven nephroprotective benefit (slowing down the progression of kidney disease, reducing microalbuminuria). Early initiation of nephroprotective treatment can significantly affect the patient’s risk and mortality. Complementary creating of the treatment by a diabetologist and a nephrologist is key in patient management. This article presents the possibilities of diabetic kidney disease management by a diabetologist, emphasizes the need for a comprehensive approach and close cooperation with other specialists.
Keywords:
diabetes mellitus – cardiovascular risk factors – diabetic kidney disease (DKD) – GLP1-receptor agonists (GLP1-RA) – holistic approach – SGLT2-inhibitors (SGLT2i)
Sources
Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney Int Suppl (2011) 2022; 12(1): 7–11. Dostupné z DOI: <http://dx.doi.org/10.1016/j.kisu.2021.11.003>.
Persson F, Rossing P. Diagnosis of diabetic kidney disease: state of the art and future perspective. Kidney Int Suppl (2011) 2018; 8(1): 2–7. Dostupné z DOI: <http://dx.doi.org/10.1016/j.kisu.2017.10.003>.
Stevens PE, Levin A. [Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members]. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med 2013; 158(11): 825–830. Dostupné z DOI: <http://dx.doi.org/10.7326/0003–4819–158–11–201306040–00007>.
Parving HH, Mauer M, Fioretto P. Diabetic nephropathy. In: Brenner B (ed). Brenner and Rector's The Kidney. Vol. 1. Elsevier; Philadelphia 2012: 1411–1454.
Draznin B, Aroda VR, Bakris G et al. [American Diabetes Association Professional Practice Committee]. 11. Chronic kidney disease and risk management: Standards of Medical Care in Diabetes – 2022. Diabetes Care 2022; 45(Suppl 1): S175–S184. Dostupné z DOI: <https://doi.org/10.2337/dc22-S011>.
Stempniewicz N, Vassalotti JA, Cuddeback JK et al. Chronic kidney disease testing among primary care patients with type 2 diabetes across 24 U.S. health care organizations. Diabetes Care 2021; 44(9): 2000–2009. Dostupné z DOI: <http://dx.doi.org/10.2337/dc20–2715>.
Martinka E. 1.1 Klinické prejavy. In: Martinka E (Ed). Interdisciplinárne odporúčania pre diagnostiku a liečbu diabetes mellitus, jeho komplikácií a najvýznamnejších sprievodných ochorení. Forum Diab 2021; 10(Suppl 2): 13–15.
American Diabetes Association. 11. Microvascular complications and foot care: standards of medical care in diabetes – 2019. Diabetes Care 2019; 42(Suppl 1): S124-S138. Dostupné z DOI: <http://dx.doi.org/10.2337/dc19-S011>.
International Diabetes Federation. Diabetes facts and figures show the growing global burden for individuals, families, and countries. The IDF Diabetes Atlas (2021) reports that 10.5% of the adult population (20–79 years) has diabetes, with almost half unaware that they are living with the condition. Dostupné z WWW: <https://idf.org/about-diabetes/diabetes-facts-figures/>.
Afsheen Syeda US, Battillo D, Visaria A et al. The importance of exercise for glycemic control in type 2 diabetes. Am J Med Open 2023; 9: 100031 Dostupné z DOI: <https://doi.org/10.1016/j.ajmo.2023.100031>.
Parving HH, Lehnert H, Brochner-Mortensen J et al. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med 2001; 345(12): 870–878. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa011489>.
Makino H, Haneda M, Babazono T et al. Prevention of transition from incipient to overt nephropathy with telmisartan in patients with type 2 diabetes. Diabetes Care 2007; 30(6): 1577–1578. Dostupné z DOI: <http://dx.doi.org/10.2337/dc06–1998>.
Agarwal R, Filippatos G, Pitt B et al. [FIDELIO-DKD and FIGARO-DKD investigators]. Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis. Eur Heart J 2022; 43(6): 474–484. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehab777>.
Pitt B, Filippatos G, Agarwal R et al. [FIGARO-DKD Investigators]. Cardiovascular events With finerenone in kidney disease and type 2 diabetes. N Engl J Med 2021; 385(24): 2252–2263. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa2110956>.
Wanner C, Tonelli M. [Kidney Disease: Improving Global Outcomes Lipid Guideline Development Work Group Members]. KDIGO clinical practice guideline for lipid management in CKD: summary of recommendation statements and clinical approach to the patient. Kidney Int 2014; 85(6): 1303–1309. Dostupné z DOI: <http://dx.doi.org/10.1038/ki.2014.31>.
Sharp Collaborative Group. Study of Heart and Renal Protection (SHARP): randomized trial to assess the effects of lowering low-density lipoprotein cholesterol among 9,438 patients with chronic kidney disease. Am Heart J 2010; 160(5): 785–794. e10. Dostupné z DOI: <https://doi: 10.1016/j.ahj.2010.08.012>.
Fellstrom BC, Jardine AG, Schmieder RE et al. [AURORA Study Group]. Rosuvastatin and cardiovascular events in patients undergoing hemodialysis. N Engl J Med 2009; 360(14): 1395–1407. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa0810177>.
Wanner C, Krane V, Marz W et al. [Deutsche Diabetes-Dialyse-Studie (4D) Study Group]. Randomized controlled trial on the efficacy and safety of atorvastatin in patients with type 2 diabetes on hemodialysis (4D study): demographic and baseline characteristics. Kidney Blood Press Res 2004; 27(4): 259–266. Dostupné z DOI: <http://dx.doi.org/10.1159/000080241>.
Fellstrom BC, Jardine AG, Schmieder RE et al. [AURORA Study Group]. Rosuvastatin and cardiovascular events in patients undergoing hemodialysis. N Engl J Med. 2009; 360(14): 1395–1407. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa0810177>.
King P, Peacock I, Donnelly R. The UK prospective diabetes study (UKPDS): clinical and therapeutic implications for type 2 diabetes. Br J Clin Pharmacol 1999; 48(5): 643–648. Dostupné z DOI: <http://dx.doi.org/10.1046/j.1365–2125.1999.00092.x>.
[Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group]. KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney Int 2022; 102(5S): S1–S123. Dostupné z DOI: <http://dx.doi.org/10.1016/j.kint.2022.06.008>.
Heerspink HJL, Stefansson BV, Correa-Rotter R et al. [DAPA-CKD Trial Committees and Investigators]. Dapagliflozin in patients with chronic kidney disease. N Engl J Med 2020; 383(15): 1436–1446. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa2024816>.
Perkovic V, Jardine MJ, Neal B et al. [CREDENCE Trial Investigators]. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med 2019; 380(24): 2295–2306. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1811744>.
Shi FH, Li H, Shen L et al. Appraisal of non-cardiovascular safety for sodium-glucose cotransporter 2 inhibitors: a systematic review and meta-analysis of placebo-controlled randomized clinical trials. Front Pharmacol 2019; 10: 1066. <http://dx.doi.org/10.3389/fphar.2019.01066>.
International Diabetes Federation. Diabetes facts and figures show the growing global burden for individuals, families, and countries. The IDF Diabetes Atlas (2021) reports that 10.5% of the adult population (20–79 years) has diabetes, with almost half unaware that they are living with the condition. Dostupné z WWW: <https://idf.org/about-diabetes/diabetes-facts-figures/>. ROVNAKÁ S CIT. 9.
Mann JFE, Fonseca V, Mosenzon O et al. Effects of liraglutide versus placebo on cardiovascular events in patients with type 2 diabetes mellitus and chronic kidney disease. Circulation 2018; 138(25): 2908–2918. Dostupné z DOI: <http://dx.doi.org/10.1161/CIRCULATIONAHA.118.036418>.
Sattar N, Lee MMY, Kristensen SL et al. Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of randomised trials. Lancet Diabetes Endocrinol 2021; 9(10): 653–662. Dostupné z DOI: <http://dx.doi.org/10.1016/S2213–8587(21)00203–5>.
De Boer IH, Alpers CE, Azeloglu EU et al. [Kidney Precision Medicine Project]. Rationale and design of the Kidney Precision Medicine Project. Kidney Int 2021; 99(3): 498–510. Dostupné z DOI: <http://dx.doi.org/10.1016/j.kint.2020.08.039>.
Heerspink HJ, Stefánsson BV, Correa-Rotter R et al. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med 2020; 383(15): 1436–1446. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa2024816>.
MZ SR. Zoznam kategorizovaných liekov 1. 4. 2024 – 30. 4. 2024. Dostupné z WWW: <https://www.health.gov.sk/?zoznam-kategorizovanych-liekov>.
Fonseca-Correa JI, Correa-Rotter R. Sodium-glucose cotransporter 2 inhibitors mechanisms of action: A review. Front Med (Lausanne) 2021; 8: 777861. Dostupné z DOI: <http://dx.doi.org/10.3389/fmed.2021.777861>.
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Forum Diabetologicum
2024 Issue 2
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