From the Guidelines
Chronic Kidney Disease (CKD) is a common microvascular complication in patients with both type 1 and type 2 diabetes, defined as persistent albuminuria or persistent reduction in estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m², or both, for at least 3 months. According to the study published in Mayo Clinic Proceedings 1, CKD is a progressive condition characterized by gradual loss of kidney function over time, and it is associated with poor quality of life, high burden of chronic diseases, and increased risk of premature death.
Key Characteristics of CKD
- Persistent albuminuria (urinary albumin excretion >30 mg/24 h or urinary albumin to creatinine ratio [UACR] >30 mg/g)
- Persistent reduction in estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m²
- Duration of at least 3 months
- Approximately 40% of patients with type 2 diabetes have CKD (stages 1 to 4), with more than half having moderate to severe disease (stage 3 and stage 4) 1
Diagnosis and Management
The terms diabetic kidney disease (DKD) and diabetic nephropathy are frequently used interchangeably, but there are important differences between them, as highlighted in the study 1. Diabetic kidney disease is a clinical diagnosis, while diabetic nephropathy is a tissue diagnosis that refers to the characteristic pathologic glomerular lesions specific to CKD caused by diabetes. Early detection of DKD is crucial, and management should focus on slowing progression and treating complications, with an integrated approach to patient care and a multidisciplinary focus.
Treatment Options
Treatment options for CKD include glycemic and blood pressure control, renin-angiotensin system blockade, and the use of newer classes of glucose-lowering agents, such as sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists, which have been shown to reduce the risk of progression of kidney disease and death 1. The American Diabetes Association, the Kidney Disease: Improving Global Outcomes, and the European Association for the Study of Diabetes now recommend the use of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists for patients with DKD to provide both kidney and cardiovascular protective benefits.
From the Research
Definition of Chronic Kidney Disease (CKD)
- Chronic kidney disease (CKD) is recognized as a worldwide epidemic 2
- CKD is defined as either kidney damage or an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m2 for more than 3 months 3
- Kidney damage is defined as pathological abnormalities or markers of damage, including abnormalities in blood or urine tests or imaging studies 3
Classification and Stages of CKD
- CKD is classified as stage 1 to 5 on the basis of eGFR 3
- The stages of CKD are based on the level of kidney function, with stage 1 being the least severe and stage 5 being the most severe
Relationship between CKD and Hypertension
- Hypertension commonly coexists with CKD and its prevalence is progressively increasing as kidney function declines 2
- Uncontrolled blood pressure (BP) in patients with CKD can lead to serious adverse outcomes, including cardiovascular events and end-stage kidney disease 4
- The renin-angiotensin system (RAS) is involved in every stage of the progression of CKD and is a critical link in the pathologic relationship between hypertension and renal disease 3
Blood Pressure Control in CKD Patients
- The target blood pressure for CKD patients is less than 130/80 mmHg, or 125/75 mmHg if the amount of urinary protein is more than 1 g/day 5, 3
- Recently, a lower systolic blood pressure target of <120 mmHg has been suggested for most individuals with CKD not receiving dialysis, based on standardized measurements 6
- Achieving an optimal blood pressure level is important to prevent the occurrence of cardiovascular events and end-stage kidney disease 4