Putting it All Together: Practical Approach to the Patient with Diabetic Kidney Disease

Diabetes is a worsening worldwide epidemic projected to affect over half the world’s population by 2045. It is a major cause of premature death and substantial morbidity resulting in blindness and cardiovascular and renal disease. In the United States and much of the world, diabetic kidney disease (DKD) is the most common cause of end-stage kidney disease. Physicians must be aware of the risk factors for the development of DKD and be particularly vigilant in screening for diabetes in vulnerable populations, and since many diabetics are unaware of their diagnosis, there is an urgent need for the healthcare team to educate affected patients. Patients with DKD have increased cardiovascular disease, and so important strategies beyond good glycemic control include prescription of cardio- and renal protective medications including angiotensin-converting enzyme inhibitors (ACE-I) or receptor blockers (ARBs) and sodium-glucose transporter-2 inhibitors (SGLT2i). Additional therapies such as glucagon-like peptide-1 receptor agonists (GLP-1RA) and the selective mineralocorticoid receptor antagonists may provide additional protective effects. Hypertension control and cholesterol management continue to be important components of DKD management.