Materiały źródłowe

• #1 Diabetic kidney disease treatment: new perspectives

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9590300/

  Diabetic kidney disease (DKD) is the leading cause of chronic kidney disease and end-stage kidney disease worldwide, as the obesity epidemic and the burden of diabetes continue to rise globally. […] The inhibition of the renin-angiotensin system (RAS) using an angiotensin-converting enzyme inhibitor or an angiotensin II receptor blocker remains the foundational therapy for DKD. […] Significant advances in therapeutics, including the sodium-glucose cotransporter-2 inhibitors (SGLT2i), the glucagon-like peptide-1 receptor agonists (GLP-1 RA), and the nonsteroidal mineralocorticoid receptor agonist (MRA) finerenone, have dramatically expanded the armamentarium for treating DKD and its cardiovascular complications. […] Initiating, optimizing, and sustaining evidence-based pharmacological therapy using a therapeutic combination of RAS inhibitor + SGLT2i/GLP-1 RA + nonsteroidal MRA + statin is likely to significantly improve outcomes for T2D with DKD.

• #1 Diabetic nephropathy – Wikipedia

  https://en.wikipedia.org/wiki/Diabetic_nephropathy

  Diabetic nephropathy, also known as diabetic kidney disease, is the chronic loss of kidney function occurring in those with diabetes mellitus. […] Treatment with an angiotensin converting enzyme inhibitor or angiotensin receptor blocker, which dilates the arteriole exiting the glomerulus, thus reducing the blood pressure within the glomerular capillaries, may slow (but not stop) progression of the disease. […] The goals of treatment are to slow the progression of kidney damage and control related complications. Management of diabetic nephropathy currently centers over four main areas: Cardiovascular risk reduction, glycemic control, blood pressure control as well as inhibition of the RAAS system. […] Angiotensin-converting-enzyme inhibitors, as well as angiotensin II receptor blockers, are particularly helpful in patients with diabetes to lower blood pressure and slow the progression of nephropathy.

• #1 Diabetic kidney disease treatment: new perspectives

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9590300/

  In patients with established DKD, treatment goals include albuminuria regression, preservation of kidney function, and lower CVD-associated morbidity and mortality. […] Large clinical trials have demonstrated that strict glycemic control prevents microvascular complications including DKD in diabetic patients. […] For most patients with T2D and DKD, metformin and an SGLT2i are recommended as the first-line pharmacologic treatment if eGFR is above 30 mL/min/1.73 m2. […] SGLT2i are now widely used antihyperglycemic therapies for T2D. […] Studies of RAS inhibition do not differentiate between the relative contribution of the RAS vs. aldosterone system blockade. […] Finerenone, which is now approved in the United States, is a nonsteroidal MRA that has greater aldosterone receptor selectivity and affinity compared to steroidal MRA, thus affording a higher potency and a lower risk of hyperkalemia. […] Initiating, optimizing, and sustaining evidence-based pharmacological therapy using combination therapeutics of RASi + SGLT2i/GLP1 RA + nonsteroidal MRA + statin may significantly improve outcomes for patients with DKD.

• #1 Diabetic Nephropathy Treatment & Management: Approach Considerations, Glycemic Control, Management of Hypertension

  https://emedicine.medscape.com/article/238946-treatment

  Long-term treatment with ACE inhibitors, usually combined with diuretics, reduces blood pressure and albuminuria and protects kidney function in patients with hypertension, type 1 DM, and nephropathy. […] ACE inhibition has been shown to delay the development of diabetic nephropathy. […] Two studies (the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan [RENAAL] Study and the Irbesartan Diabetic Nephropathy Trial [IDNT]) demonstrated that angiotensin II receptor blockers (ARBs) are superior to conventional therapy and amlodipine in slowing the progression of overt nephropathy. […] In July 2021, the FDA approved finerenone (Kerendia) to lower the chances of sustained eGFR decline, end-stage kidney disease, cardiovascular death, nonfatal myocardial infarction, and hospitalization for heart failure in adults with chronic kidney disease (CKD) associated with type 2 DM.

• #1 Chronic Kidney Disease in Diabetes – Diabetes Canada

  https://www.diabetes.ca/health-care-providers/clinical-practice-guidelines/chapter-29

  In type 2 diabetes, ACE inhibitors and ARBs have been shown to decrease albuminuria and prevent worsening of kidney disease, and ARBs have been shown to delay the time to dialysis in those with renal dysfunction at baseline. […] The presence of clinical or laboratory abnormalities suggesting non-diabetic kidney disease indicates the need for appropriate work-up or referral.

• #1 Treatment of Diabetic Kidney Disease: Current and Future

  https://www.e-dmj.org/journal/view.php?doi=10.4093/dmj.2020.0217

  Diabetic kidney disease (DKD) is the major cause of end-stage kidney disease. However, only renin-angiotensin system inhibitor with multidisciplinary treatments is effective for DKD. In 2019, sodium-glucose cotransporter 2 (SGLT2) inhibitor showed efficacy against DKD in Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) trial, adding a new treatment option. […] Multi-disciplinary treatments, including blood glucose control, blood pressure and lipid control with renin-angiotensin-aldosterone system (RAS) inhibitors, appropriate weight management, and guidance for diet and smoking cessation, are important. […] Sodium-glucose cotransporter 2 (SGLT2) inhibitors were also added as a new drug of choice for DKD treatment in 2019, as the Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) study showed that SGLT2 inhibitors inhibited DKD progression.

• #1 New Medications for Type 2 Diabetes and Kidney Disease: SGLT2 Inhibitors, Finerenone, and GLP-1 RA | National Kidney Foundation

  https://www.kidney.org/news-stories/game-changing-medications-kidney-disease-and-type-2-diabetes

  Before the existence of three new medications designed to help individuals with type 2 diabetes and kidney disease or early-stage kidney disease, we only had ACE inhibitors and angiotensin II receptor blockers that were kidney protective and managed blood pressure. Now we have SGLT2 inhibitors and Finerenone which are also kidney protective. […] „The SGLT-2 inhibitors or Flozins that have been shown in randomized clinical trials to reduce the risk of kidney failure by about 30 to 40%,” said Dr. Vassalotti, NKF’s Chief Medical Officer. „They also reduce the risk of heart failure hospitalization and death, so, these are really powerful medications and a new tool to treat people living with kidney disease to prevent kidney failure and reduce complications.” […] SGLT2 inhibitors are FDA-approved to help lower blood sugar in adults with type 2 diabetes and people with kidney disease with an eGFR as low as 20 (CKD stage 4). They may also protect the kidney function of people with early kidney disease who do not have diabetes but have albumin, a type of protein, in the urine.

• #1 Diabetic Nephropathy Symptoms, Causes, and Treatment

  https://www.webmd.com/diabetes/diabetes-kidney-disease

  Diabetic nephropathy — kidney disease that results from diabetes — is the number one cause of kidney failure. Almost a third of people with diabetes develop diabetic nephropathy. […] Treatments are available that can help slow progression to kidney failure. That’s why you should have your urine tested every year if you have diabetes. […] Lowering blood pressure and maintaining blood sugar control are absolutely necessary to slow the progression of diabetic nephropathy. There are medications available which have been found to slow down the progression of kidney damage. They include: SGLT2 inhibitors including bexagliflozin (Brenzavvy), dapagliflozin (Farxiga), empagliflozin (Jardiance), and ertugliflozin (Steglatro), which help control high blood sugar. […] Angiotensin converting enzyme (ACE) inhibitors can help slow down the progression of kidney damage. […] If not treated, the kidneys will continue to fail and larger amounts of proteins can be detected in the urine. Advanced kidney failure requires treatment with dialysis or a kidney transplant.

• #1 Treatment of Diabetic Kidney Disease: Current and Future

  https://www.e-dmj.org/journal/view.php?doi=10.4093/dmj.2020.0217

  The combination therapy of ACE-I and ARB was also studied in large randomized trials. […] Both large clinical trials and basic experiments have a solid evidence that RAS inhibitors, especially ACE-I and ARB, can treat DKD. […] SGLT2 inhibitors are also known to cause a mild increase of ketones in the blood. […] The advantages of SGLT2 inhibitor for the treatment of DKD include its efficacy when combined with RAS inhibitor and its ability to treat DKD independently of the hypoglycemic effect. […] Nrf2 activator is a novel drug that improves the kidney function in DKD patients. […] HIF-PH inhibitor has been recently approved for renal anemia and has the potential to be effective against CKD and DKD by enhancing the biological response to hypoxia. […] AGE and histone modification inhibitors are expected to become breakthroughs in DKD treatment.

• #1 New Medications for Type 2 Diabetes and Kidney Disease: SGLT2 Inhibitors, Finerenone, and GLP-1 RA | National Kidney Foundation

  https://www.kidney.org/news-stories/game-changing-medications-kidney-disease-and-type-2-diabetes

  SGLT2 inhibitors are effective for patients with albumin in the urine with or without type-2 diabetes: Slowing the progression of kidney disease, Reducing heart failure hospitalization, Lowering the risk of kidney failure, Reducing the risk of death. […] Finerenone is FDA-approved for those with type 2 diabetes-associated kidney disease who have an eGFR above 25 and a urine-albumin creatinine ratio above 30. It may improve kidney and heart outcomes by preventing fibrosis or scarring of the kidneys. […] According to the FDA, Finerenone is effective at reducing the risk of: Kidney function decline, Kidney failure, Hospitalization for heart failure. […] If you have diabetes and kidney disease or early-stage kidney disease without diabetes, ask your doctor if you could benefit from any of these medications. […] If you have CKD with or without type 2 diabetes, ask if SGLT2 inhibitors are right for me. […] If you have CKD with type-2 diabetes, also ask if Finerenone, or GLP-1 receptor agonists, are right for me.

• #1 Diabetic Kidney Disease: Diagnosis, Treatment, and Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0615/p751.html

  Globally, approximately 20% of the 400 million individuals with diabetes mellitus have diabetic kidney disease (DKD). DKD is associated with higher cardiovascular and all-cause morbidity and mortality, so timely diagnosis and treatment are critical. […] Treatment includes management of hyperglycemia, hypertension, hyperlipidemia, and cessation of tobacco use. Multiple antihyperglycemic medications, including sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, and dipeptidyl-peptidase-4 inhibitors, may help prevent DKD by lowering blood glucose levels and through intrinsic renal protection. […] Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers prevent progression of DKD and may decrease albuminuria. Statin therapy should be considered for all patients with DKD, and tobacco cessation reduces the risk of DKD.

• #1 Diabetic kidney disease – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/530

  Diabetic kidney disease (DKD) is usually a clinical diagnosis in a patient with long-standing diabetes (10 years) with albuminuria and/or reduced estimated glomerular filtration rate (eGFR) in the absence of signs or symptoms of other primary causes of kidney damage. […] Treatment includes intensive management of hyperglycaemia and treatment of hypertension with ACE inhibitors, angiotensin-II receptor antagonists, or other antihypertensives. Lipid reduction and smoking cessation may be beneficial. Sodium-glucose co-transporter-2 (SGLT2) inhibitors are moderately to highly effective at glycaemic control and very effective at reducing proteinuria and slowing the progression of DKD. Glucagon-like peptide 1 (GLP-1) receptor agonists are highly effective antidiabetic medications with benefits of moderate to marked weight loss, and their use improves kidney and cardiovascular outcomes. Finerenone is the first non-steroidal mineralocorticoid receptor antagonist to demonstrate positive renal and cardiovascular outcomes in patients with DKD.

• #1 Therapeutic Advances in Diabetic Nephropathy

  https://www.mdpi.com/2077-0383/11/2/378

  GLP-1 has also shown to have numerous kidney protective effects, including the inhibition of the inflammatory effects of angiotensin II and the inhibition of oxidative stress and albuminuria, as well as an ability to ameliorate albuminuria, glomerular hyperfiltration, glomerular hypertrophy and mesangial matrix expansion in animal models. […] Finerenone is a welcome addition to our armamentarium, promising the same benefits of steroidal MRAs, but with less side effects. […] Given the role various inflammatory pathways have been shown to play in the progression of DKD, pharmacologic intervention targeting these pathways have been areas of interest for potential treatment approaches. […] The future of DKD management has the potential to include a more personalized approach, where each patient can have a tailored treatment regimen based on their genetic and biomarker profile. […] These expanded therapeutic options have ushered in a new era of DKD management, enabling, cardiovascular, kidney, and survival benefits.

• #1 Diabetic nephropathy (kidney disease) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetic-nephropathy/diagnosis-treatment/drc-20354562

  Diabetic nephropathy usually is diagnosed during the regular testing that’s part of managing diabetes. […] The first step in treating diabetic nephropathy is to treat and control diabetes and high blood pressure. Treatment includes diet, lifestyle changes, exercise and prescription medicines. Controlling blood sugar and blood pressure might prevent or delay kidney issues and other complications. […] In the early stages of diabetic nephropathy, your treatment might include medicines to manage the following: […] Medicines called angiotensin-converting enzyme (ACE) inhibitors and angiotensin 2 receptor blockers (ARBs) are used to treat high blood pressure. […] Medicines can help control high blood sugar in people with diabetic nephropathy. […] Cholesterol-lowering drugs called statins are used to treat high cholesterol and lower the amount of protein in urine.

• #1 Diabetic Nephropathy – Genitourinary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/genitourinary-disorders/glomerular-disorders/diabetic-nephropathy

  Dyslipidemia should also be treated. […] Statins should be used as first-line therapy for dyslipidemia treatment in patients with diabetic nephropathy because they reduce cardiovascular mortality and urinary protein. […] Kidney transplantation with or without simultaneous or subsequent pancreas transplantation is an option for patients with kidney failure. […] Treat blood pressure aggressively, usually beginning with angiotensin inhibition. […] Treat increased albuminuria with angiotensin inhibition. […] Control glucose to maintain HbA1C at 7.0. […] Treat dyslipidemia with a statin.

• #1 Patient education: Diabetic kidney disease (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/diabetic-kidney-disease-beyond-the-basics/print

  A blood test called A1C is also used to monitor blood sugar levels; the result provides an average of blood sugar levels over the last one to three months. An A1C of 7 percent or less is usually recommended; this corresponds to an average blood glucose of 150 mg/dL (8.3 mmol/L) (table 1). Even small decreases in the A1C lower the risk of diabetes-related complications to some degree. […] Managing your blood sugar involves lifestyle changes (eg, diet and exercise) as well as medications. Type 1 diabetes is treated with insulin. For type 2 diabetes, other medications are often used; some are not recommended for use in people with kidney problems, while others may help slow the progression of kidney disease. Your doctors will work with you to determine what combination of medications is best for you.

• #1 Diabetic nephropathy – Wikipedia

  https://en.wikipedia.org/wiki/Diabetic_nephropathy

  RAAS inhibition has been proven to be the most effective therapy to slow the progression of diabetic nephropathy in all stages. […] About half of insulin is metabolized and cleared by the kidneys. This means that as kidney function worsens in the setting of DN, some patients with insulin-dependent DM may find that their regular insulin doses are lasting longer than normal, or that they are experiencing an increasing frequency of hypoglycemic episodes. […] Some evidence suggests that limiting dietary protein could slow the progression of DN, but further evidence is needed to confirm this benefit. […] Patients with diabetic nephropathy might go on to develop end stage renal disease and require kidney transplantation or hemodialysis. […] A relatively new medication that has been approved for treatment for DM is sodium glucose cotransporter 2 (SGLT2) inhibitors. […] Other classes of diabetic medications that have been shown to have a positive effect on the progression of diabetic nephropathy are GLP-1 agonists and DPP-4 inhibitors.

• #1 Diabetic Nephropathy – Genitourinary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/genitourinary-disorders/glomerular-disorders/diabetic-nephropathy

  Diabetic nephropathy is glomerular sclerosis and fibrosis caused by the metabolic and hemodynamic changes of diabetes mellitus. […] Treatment is strict glucose control, angiotensin inhibition (using angiotensin-converting enzyme [ACE] inhibitors or angiotensin II receptor blockers [ARBs]), and control of blood pressure and lipids. […] Primary treatment is strict glucose control to maintain HbA1C 7.0; maintenance of euglycemia reduces microalbuminuria but may not retard disease progression once diabetic nephropathy is well-established. […] Glucose control must also be accompanied by strict control of BP to 130/80 mm Hg, although some experts recommend BP 140/90 mm Hg. […] Angiotensin inhibition is first-line therapy. Thus, angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) are the antihypertensives of choice; they reduce BP and proteinuria and slow the progression of diabetic nephropathy.

• #1 Diabetic Nephropathy Treatment & Management: Approach Considerations, Glycemic Control, Management of Hypertension

  https://emedicine.medscape.com/article/238946-treatment

  Several issues are key in the medical care of patients with diabetic nephropathy. These include glycemic control, management of hypertension, reduction of dietary salt intake, and, in advanced cases, phosphorus and potassium restriction. […] Renal replacement therapy may be necessary in patients with end-stage renal disease (ESRD). […] Guidelines from the organization Kidney Disease: Improving Global Outcomes (KDIGO) look at diabetes management in the context of chronic kidney disease, including with regard to comprehensive care, glycemic monitoring and targets, interventions addressing lifestyle and hyperglycemia, and approaches to self-management and models for optimal care. […] In general, antihypertensive therapy, irrespective of the agent used, slows the development of diabetic glomerulopathy.

• #1 Patient education: Diabetic kidney disease (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/diabetic-kidney-disease-beyond-the-basics/print

  Managing high blood pressure — Many people with diabetes have hypertension (high blood pressure). Although high blood pressure causes few symptoms, it has two negative effects: it stresses the cardiovascular system and speeds the development of diabetic complications of the kidney and eye. A health care provider can diagnose high blood pressure by measuring blood pressure on a regular basis. (See „Patient education: High blood pressure in adults (Beyond the Basics)”.) […] The treatment of high blood pressure varies. If you have mild hypertension, your health care provider may recommend weight loss, exercise, decreasing the amount of salt in the diet, quitting smoking, and decreasing alcohol intake. These measures can sometimes reduce blood pressure to normal. (See „Patient education: High blood pressure, diet, and weight (Beyond the Basics)”.)

• #1 Patient education: Diabetic kidney disease (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/diabetic-kidney-disease-beyond-the-basics/print

  If these measures are not effective or your blood pressure needs to be lowered quickly, your provider will likely recommend one of several high blood pressure medications. Your provider can discuss the pros and cons of each medication and the goals of treatment. (See „Patient education: High blood pressure treatment in adults (Beyond the Basics)”.) […] A blood pressure reading below 130/80 is the recommended goal for most people with diabetic kidney disease, especially if you have more than 300 mg of albumin in your urine per day. […] Blood pressure medications — All people with diabetic kidney disease need at least one medication to lower their blood pressure, and in most cases two medications are needed. Several medications can be used for this purpose, but a medication known as an angiotensin-converting enzyme inhibitor (abbreviated ACE inhibitor) or a related drug known as an angiotensin receptor blocker (ARB) should be used because they limit the worsening of kidney disease.

• #1 Diabetic Kidney Disease: Diagnosis, Treatment, and Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0615/p751.html

  Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) delay and reduce the progression of DKD. […] Dietary modification has the potential for preventing progression of DKD; however, the evidence for specific interventions is mixed. The American Diabetes Association recommends a protein-restricted diet (0.8 g per kg per day) in patients with DKD, based on studies that show that this can slow the decline of GFR and progression to ESRD.

• #1 Diabetic Nephropathy Treatment & Management: Approach Considerations, Glycemic Control, Management of Hypertension

  https://emedicine.medscape.com/article/238946-treatment

  A study by Ueno indicated that in patients with type 2 diabetes with hyperuricemia, kidney function significantly improves when serum urate levels are reduced below 6.0 mg/dL, possibly demonstrating a means of slowing nephropathy progression in these patients. […] A meta-analysis examining the effects of dietary protein restriction (0.5-0.85 g/kg/d) in diabetic patients suggested a beneficial effect on the GFR, creatinine clearance, and albuminuria. […] Dietary salt reduction may help slow progression of kidney disease in both type 1 and type 2 diabetes.

• #1 Diabetic Nephropathy – DaVita

  https://www.davita.com/education/kidney-disease/related-diseases/diabetic-nephropathy

  Low protein diets have been promoted for people with chronic kidney disease to decrease the kidneys workload and perhaps delay progression of kidney failure. […] Nutritional assessment by a dietitian to determine protein status and protein requirements is recommended before going on a low protein diet. Most people with diabetes need between .8 to 1.0 grams of protein per kilogram of body weight. Optimal blood sugar control is extremely important. Most people with diabetes require between 10 percent up to 20 percent of their calories from protein. The amount must be based on each persons nutritional status, kidney function and individual needs.

• #1 Chronic kidney disease (CKD) – Symptoms, causes, treatment | National Kidney Foundation

  https://www.kidney.org/kidney-topics/chronic-kidney-disease-ckd

  Managing CKD is focused on four very important goals: […] Specific treatment recommendations depend on your stage of CKD and what other health conditions you have (including any CKD complications). Below are recommendations that apply to most people with CKD. No two people are the same, so talk with your healthcare professional about recommendations tailored to you. […] Your healthcare professional may prescribe one or more medicines to help slow down or stop your CKD from getting worse. These medicines can include an ACE inhibitor/ARB, an SGLT2 inhibitor and/or an nsMRA. […] Your healthcare professional may also prescribe a statin (cholesterol medicine). Guidelines recommend a statin for people with CKD who also have diabetes, a history of heart disease, or are age 50 or older. […] It is important to limit your sodium (salt) intake to less than 2300 mg per day (about 1 teaspoon of salt from all the food and drinks you consume each day).

• #1 Diabetes and Kidney Disease: What to Eat? | Diabetes | CDC

  https://www.cdc.gov/diabetes/healthy-eating/diabetes-and-kidney-disease-food.html

  Your individual carb goal is based on your age, activity level, any medicines you take, and other factors. Following your meal plan will help keep blood sugar levels in your target range. This will also prevent more damage to your kidneys. […] Depending on your kidney disease stage, you may also need to reduce the potassium, phosphorus, and protein in your diet. Many foods that are part of a typical healthy diet may not be right for a CKD diet. […] Your dietitian can help you figure out the right combination and amount of protein to eat. […] Herbal supplements aren’t safe if you have kidney disease. Some can hurt your kidneys and even make kidney disease worse. […] If you’re on dialysis, you may need to eat more, especially more protein. Your appetite can change because food tastes different. […] Your blood sugar levels can actually get better with late-stage CKD. This may happen because of changes in how your body uses insulin. But when you’re on dialysis, your blood sugar can increase.

• #1 Diabetic Nephropathy: Causes, Symptoms, Treatment, Outlook, and More

  https://www.verywellhealth.com/diabetic-nephropathy-8665334

  People with diabetic nephropathy need to follow a diet that is healthy for their diabetes but also their kidneys. The following eating patterns may be beneficial: Avoiding foods high in sugar and processed carbohydrates (e.g., cookies and soft drinks); Eating a diet with whole-grain carbohydrates and fiber, like from oatmeal and fresh fruits and vegetables; Eating foods high in omega-3 fatty acids, such as fish like salmon; Limiting protein (especially from proteins high in saturated fats, like beef or other animal source); Limiting sodium to 2,300 mg per day or less. […] People with end-stage (stage 5) kidney failure from diabetes will die of the condition unless they are treated with dialysis or a kidney transplant. […] The majority of people with end-stage kidney disease go on dialysis. In this approach, you are connected to a machine that cleans your blood similar to how your kidneys would have done. […] Some people with diabetic nephropathy can get a kidney transplant. In some cases, healthcare providers combine a kidney transplant with a pancreas transplant to treat diabetes directly.

• #1 Patient education: Diabetic kidney disease (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/diabetic-kidney-disease-beyond-the-basics/print

  Lifestyle changes — Changing your lifestyle can have a big impact on the health of your kidneys. The following measures are recommended for everyone, but are especially important if you have diabetic kidney disease: […] • Limit the amount of sodium (salt) you eat to less than 2 grams per day) (see „Patient education: Low-sodium diet (Beyond the Basics)”) […] • If you smoke, quit smoking (see „Patient education: Quitting smoking (Beyond the Basics)”) […] • Lose weight if you are overweight (see „Patient education: Diet and health (Beyond the Basics)” and „Patient education: Exercise (Beyond the Basics)” and „Patient education: Losing weight (Beyond the Basics)”) […] Blood sugar control — Keeping blood sugars close to normal can help prevent the long-term complications of diabetes mellitus. For most people, a target for fasting blood glucose and for blood glucose levels before each meal is 80 to 120 mg/dL (4.4 to 6.6 mmol/L); however, these targets may need to be individualized. (See „Patient education: Glucose monitoring in diabetes (Beyond the Basics)”.)

• #1 Diabetic nephropathy services – Overview – Mayo Clinic

  https://www.mayoclinic.org/departments-centers/diabetic-nephropathy-clinic/overview/ovc-20464936

  The Mayo Clinic experts who offer diabetic nephropathy services provide skilled diagnosis and individualized treatment plans to people with diabetic nephropathy (diabetic kidney disease). […] If you receive a diagnosis of diabetic nephropathy, your doctor will talk with you about the full range of treatment options to help slow down disease progression. Your care team will monitor how you are responding to treatment and adjust your treatment plan when needed. […] Your care plan may include: […] Medications to help manage and improve kidney function, high blood pressure (hypertension), blood sugar control, anemia and cholesterol level […] Nutrition counseling, with development of a customized dietary plan to limit salt, protein, caffeine and alcohol intake […] Conversations with your care team about lifestyle changes to maintain good health, such as smoking cessation, exercise and weight management

• #1 Chronic kidney disease (CKD) – Symptoms, causes, treatment | National Kidney Foundation

  https://www.kidney.org/kidney-topics/chronic-kidney-disease-ckd

  People with CKD should also avoid certain pain medicines known as non-steroid anti-inflammatory drugs (NSAIDs). These can be harmful to your kidneys, especially at higher doses and/or with long-term use. […] If your healthcare professional says you have metabolic acidosis, increasing the amount of fruits and vegetables you eat everyday can help lower the level of acid in your blood. This can also help slow down your CKD progression (worsening).

• #1 Diabetic nephropathy (kidney disease) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetic-nephropathy/diagnosis-treatment/drc-20354562

  Finerenone (Kerendia) might help reduce tissue scarring in diabetic nephropathy. […] During kidney transplant surgery, the donor kidney is placed in the lower abdomen. […] For kidney failure, also called end-stage kidney disease, treatment focuses on either replacing the work of your kidneys or making you more comfortable. […] Options include: Kidney dialysis. […] Sometimes, a kidney transplant or a kidney-pancreas transplant is the best treatment choice for kidney failure. […] In the future, people with diabetic nephropathy may benefit from treatments being developed using techniques that help the body repair itself, called regenerative medicine. […] These techniques may help reverse or slow kidney damage.

• #1 Diabetic nephropathy: Symptoms, stages, causes, and treatment

  https://www.medicalnewstoday.com/articles/319686

  The main aim of treatment is to maintain and control blood glucose levels and blood pressure. This may involve the use of medication. […] Angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) can help lower blood pressure, protect kidney function, and prevent further damage. […] Kerendia (finerenone) is a prescription medicine that can reduce the risk of sustained GFR decline, end-stage kidney disease, cardiovascular death, nonfatal myocardial infarction, and hospitalization for heart failure in adults with CKD associated with type 2 diabetes. […] In 2018, the American College of Cardiology issued guidelines recommending the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors or glucagon-like peptide-1 receptor agonists (GLP-1RAs) for people with type 2 diabetes and CKD. These drugs may reduce the risk of CKD progression, cardiovascular events, or both.

• #1 Diabetic nephropathy Guide: Causes, Symptoms and Treatment Options

  https://www.drugs.com/health-guide/diabetic-nephropathy.html

  If you have diabetes with microalbuminuria or blood test evidence of kidney disease, you can slow the progression of kidney disease by taking a drug called an SGLT2 inhibitor. Examples of SGLT2 inhibitors approved to help preserve kidney function even in people without diabetes include canagliflozin (Invokana) and dapagliflozin (Farxiga). […] If you have diabetes and high blood pressure, doctors usually prescribe a medication from the ACE inhibitor or ARB group as part of the hypertension treatment program. These medications slow the progression of kidney disease in people with diabetes, although kidney disease continues to develop gradually. […] Reducing the amount of protein in your diet also may be helpful to slow progressing kidney disease. […] Once nephropathy reaches advanced stages, you may need dialysis to remove waste products from the blood. There are two types of dialysis, hemodialysis and peritoneal dialysis.

• #1 Diabetic nephropathy Guide: Causes, Symptoms and Treatment Options

  https://www.drugs.com/health-guide/diabetic-nephropathy.html

  An alternative way to treat advanced kidney disease is with a kidney transplant. Kidney transplants have allowed many people with severe kidney disease to avoid or discontinue dialysis. […] In a person with type 1 diabetes and kidney failure, a kidney-pancreas transplant is another possible treatment. This option is available only for a small number of people because of the scarcity of organ donors, the risks of the surgery, and the need for lifelong immunosuppressive drugs. […] The following list of medications are related to or used in the treatment of this condition. […] Although kidney failure cannot always be prevented, worsening can be slowed with medications and control of risk factors. When full kidney failure occurs, dialysis and a kidney transplant are options that allow people to continue to lead active lives.

• #1 Diabetic nephropathy: Symptoms, stages, causes, and treatment

  https://www.medicalnewstoday.com/articles/319686

  If diabetic nephropathy progresses to ESRD, a person will need either dialysis or a kidney transplant. […] Kidney dialysis is a procedure that typically uses a machine to separate waste products from the blood and remove them from the body. […] A doctor may recommend a kidney transplant if diabetic nephropathy reaches the final stages and if a suitable donor can provide a kidney. […] The outlook for people with diabetic nephropathy will depend on how well they manage their blood sugar and blood pressure levels and the stage at which they receive a diagnosis. The earlier treatment starts, the better the outlook. […] Treatment can delay or prevent the progress of diabetic nephropathy.

• #1 Diabetes-Related Nephropathy: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24183-diabetic-nephropathy

  Diabetes-related nephropathy is a slow-moving condition. If you have diabetes-related nephropathy, you can’t reverse damage to your kidney. However, an early diagnosis and following your treatment plan can slow down or even stop diabetes-related nephropathy from advancing. […] The only treatment options for kidney failure are dialysis or a kidney transplant.

• #1 Management of diabetes mellitus in patients with chronic kidney disease | Cardiovascular Diabetology – Endocrinology Reports | Full Text

  https://clindiabetesendo.biomedcentral.com/articles/10.1186/s40842-015-0001-9

  The data clearly show that lowering A1c leads to benefit in regards to nephropathy. […] The management of patients with diabetes and nephropathy necessitates attention to several aspects of care. Importantly, glycemic control should be optimized for the patient, attaining the necessary control to reduce complications but done in a safe, monitored manner. […] Prevention and treatment of diabetic nephropathy and other complications necessitates a multifactorial approach through the use of a diabetologist, nephrologist, dietician, diabetes educator and additional specialists experienced in the complications of diabetes to provide a multifaceted care program to reduce progression of disease.

• #1 Diabetic Nephropathy | Kidney Disease | abbvieclinicaltrials.com

  https://www.abbvieclinicaltrials.com/health-conditions/diabetic-nephropathy/

  Diabetic kidney disease, or diabetic nephropathy, is a complication of type 1 or type 2 Diabetes caused by damage to the kidneys’ delicate filtering system. […] Patients who have diabetic nephropathy need to monitor their kidney function through medical tests including measurement of urine albumin (protein), blood creatinine and estimated glomerular filtration rate (eGFR) to prevent their condition from worsening, and to understand and manage the risk of heart disease, which often occurs in patients with diabetic nephropathy. […] Treatment plans are usually tailored to each individual’s unique circumstances, but here are some General options for treating diabetic nephropathy: […] If these methods fail, there are medicines that can help lower blood pressure. Doctors usually recommend that drugs called ACE inhibitors or angiotensin receptor blockers be used in patients with Diabetes and high blood pressure.

• #1 Patient education: Diabetic kidney disease (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/diabetic-kidney-disease-beyond-the-basics/print

  In people with reduced kidney function, they should be used because they reduce the risk of worsening kidney disease and risk of developing heart failure. […] Ongoing monitoring — After beginning treatment and lifestyle changes to stall kidney disease, you will need to have repeat urine and blood tests to determine if urine albumin levels have improved. If the urine albumin levels have not improved or your kidney function has worsened, your health care provider may need to adjust your medications or recommend other strategies to protect your kidneys.

• #1 Pillars of Diabetic Kidney Disease Treatment – Renal and Urology News

  https://www.renalandurologynews.com/features/diabetic-kidney-disease-treatment/

  When it comes to kidney protection, all 3 recently approved drug classes target inflammation and fibrosis in the kidney. SGLT2i (eg, dapagliflozin, empagliflozin, canagliflozin) and GLP1-RA (eg, semaglutide, liraglutide, and dulaglutide), also treat metabolic abnormalities of DKD. SGLT2i and the nonsteroidal MRA finerenone also target hemodynamic abnormalities. […] Given early evidence of additive benefit when using [guideline-directed medical therapy] in combination, a 4 pillar strategy has been proposed to maximize risk reduction in patients with cardiokidney-metabolic conditions, according to Dr Tuttle, who is also professor of medicine at the University of Washington, and colleagues. […] The 2022 guidelines from the Kidney Disease Improving Global Outcomes (KDIGO) organization provided a holistic approach to improving outcomes in patients with diabetes and CKD:

• #1 Diabetic Nephropathy: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/238946-overview

  Good evidence suggests that early treatment delays or prevents the onset of diabetic nephropathy or diabetic kidney disease. This has consistently been shown in both type 1 and type 2 diabetes mellitus. […] Several issues are key in the medical care of patients with diabetic nephropathy. These include glycemic control, management of hypertension, and reducing dietary salt intake and phosphorus and potassium restriction in advanced cases. […] Agents for glycemic control in patients with diabetes who have kidney disease include the following: Dipeptidyl peptidase inhibitors, Alpha-glucosidase inhibitors, Sodium-glucose cotransporter 2 (SGLT2) inhibitors, Glucagonlike peptide-1 (GLP-1) receptor agonists or incretin mimetics, Amylin analogs, Nonsteroidal, selective mineralocorticoid receptor (MR) antagonists.

• #2 Diabetic Kidney Disease: Diagnosis, Treatment, and Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0615/p751.html

  Globally, approximately 20% of the 400 million individuals with diabetes mellitus have diabetic kidney disease (DKD). DKD is associated with higher cardiovascular and all-cause morbidity and mortality, so timely diagnosis and treatment are critical. […] Treatment includes management of hyperglycemia, hypertension, hyperlipidemia, and cessation of tobacco use. Multiple antihyperglycemic medications, including sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, and dipeptidyl-peptidase-4 inhibitors, may help prevent DKD by lowering blood glucose levels and through intrinsic renal protection. […] Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers prevent progression of DKD and may decrease albuminuria. Statin therapy should be considered for all patients with DKD, and tobacco cessation reduces the risk of DKD.

• #2 Diabetic kidney disease treatment: new perspectives

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9590300/

  In patients with established DKD, treatment goals include albuminuria regression, preservation of kidney function, and lower CVD-associated morbidity and mortality. […] Large clinical trials have demonstrated that strict glycemic control prevents microvascular complications including DKD in diabetic patients. […] For most patients with T2D and DKD, metformin and an SGLT2i are recommended as the first-line pharmacologic treatment if eGFR is above 30 mL/min/1.73 m2. […] SGLT2i are now widely used antihyperglycemic therapies for T2D. […] Studies of RAS inhibition do not differentiate between the relative contribution of the RAS vs. aldosterone system blockade. […] Finerenone, which is now approved in the United States, is a nonsteroidal MRA that has greater aldosterone receptor selectivity and affinity compared to steroidal MRA, thus affording a higher potency and a lower risk of hyperkalemia. […] Initiating, optimizing, and sustaining evidence-based pharmacological therapy using combination therapeutics of RASi + SGLT2i/GLP1 RA + nonsteroidal MRA + statin may significantly improve outcomes for patients with DKD.

• #2 Patient education: Diabetic kidney disease (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/diabetic-kidney-disease-beyond-the-basics/print

  DIABETIC KIDNEY DISEASE TREATMENT […] People with diabetes often focus on keeping their blood sugar levels in the right ranges. And while it is important to control blood sugar, it turns out that controlling blood pressure is at least as important. That’s because high blood sugar and high blood pressure work in concert to damage the blood vessels and organ systems. […] For these reasons, the most important things you can do to stall kidney disease and protect against other diabetes complications are to: […] • Make healthy lifestyle choices […] • Keep your blood sugar as close to normal as possible (see 'Blood sugar control’ below) […] • Keep your blood pressure below 130/80, if possible (see 'Managing high blood pressure’ below) […] Most people with type 2 diabetes and kidney disease should be treated with a sodium-glucose cotransporter 2 (SGLT2) inhibitor. If there is still albumin in the urine after treatment with appropriate blood pressure medicines and an SGLT2 inhibitor, then a drug called finerenone should also be used. (See 'SGLT2 inhibitors’ below.)

• #2 Therapeutic Advances in Diabetic Nephropathy

  https://www.mdpi.com/2077-0383/11/2/378

  Diabetic kidney disease (DKD) is the most common cause of end-stage kidney disease (ESKD) in the United States. Risk factor modification, such as tight control of blood glucose, management of hypertension and hyperlipidemia, and the use of renin–angiotensin–aldosterone system (RAAS) blockade have been proven to help delay the progression of DKD. […] In recent years, new therapeutics including sodium-glucose transport protein 2 (SGLT2) inhibitors, endothelin antagonists, glucagon like peptide-1 (GLP-1) agonists, and mineralocorticoid receptor antagonists (MRA), have provided additional treatment options for patients with DKD. This review discusses the various treatment options available to treat patients with diabetic kidney disease. […] The renin–angiotensin–aldosterone system (RAAS) blockade, with angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB), was the sole treatment option for diabetic kidney disease (DKD) for about 20 years.

• #2 Patient education: Diabetic kidney disease (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/diabetic-kidney-disease-beyond-the-basics/print

  ACE inhibitors and ARBs are particularly useful for people with diabetic kidney disease because they decrease the amount of albumin in the urine and can prevent or slow the progression of diabetes-related kidney disease. In fact, the kidney benefits of ACE inhibitors and ARBs are so robust that health care providers sometimes prescribe them for people with diabetic kidney disease who have normal blood pressure. […] Still, despite their kidney-protecting abilities, ACE inhibitors and ARBs do have their downsides. For instance, ACE inhibitors cause a persistent dry cough in 5 to 20 percent of the people who take them, even up to 50 percent among Asian populations. Some people get used to the cough; others find it so disruptive that they cannot continue taking an ACE inhibitor. For them, ARBs are often a good alternative, because ARBs do not cause a cough.

• #2 Chronic Kidney Disease in Diabetes – Diabetes Canada

  https://www.diabetes.ca/health-care-providers/clinical-practice-guidelines/chapter-29

  Additionally, intensive glycemic control, optimization of blood pressure (BP), and the use of renal protective drugs, can slow or stop progression of diabetic nephropathy. […] Blockade of the renin angiotensin aldosterone system (RAAS) with either an angiotensin converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB) can reduce the risk of developing CKD in diabetes independent of their effect on BP. […] Additionally, progression of CKD in diabetes can be slowed through the use of an ACE inhibitor or ARB, independent of their effect on BP, and these two medication classes appear to be equally effective for cardiorenal protection. […] In type 1 diabetes, ACE inhibitors have been shown to decrease albuminuria and prevent worsening of nephropathy, and ARBs have been shown to reduce albuminuria.

• #2 A Narrative Review of New Treatment Options for Diabetic Nephropathy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9889842/

  The Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) trial, which presented a replacement treatment in 2019, demonstrated the effectiveness of a sodium-glucose cotransporter-2 (SGLT2) inhibitor against DKD. […] Additionally, incretin-related drugs have demonstrated nephroprotective effects in several clinical investigations; this research, whose main objective is kidney outcome, is still underway. […] The most effective medications include those that block the renin-angiotensin system as well as newer hypoglycemic drugs such as sodium-glucose cotransporter-2 (SGLT2) and glucagon-like peptide-1 (GLP-1) inhibitors. […] In addition, newly developed drugs such as advanced glycation end product (AGE) inhibitors and aldosterone receptor inhibitors may be effective in treating DN.

• #2 New Medications for Type 2 Diabetes and Kidney Disease: SGLT2 Inhibitors, Finerenone, and GLP-1 RA | National Kidney Foundation

  https://www.kidney.org/news-stories/game-changing-medications-kidney-disease-and-type-2-diabetes

  SGLT2 inhibitors are effective for patients with albumin in the urine with or without type-2 diabetes: Slowing the progression of kidney disease, Reducing heart failure hospitalization, Lowering the risk of kidney failure, Reducing the risk of death. […] Finerenone is FDA-approved for those with type 2 diabetes-associated kidney disease who have an eGFR above 25 and a urine-albumin creatinine ratio above 30. It may improve kidney and heart outcomes by preventing fibrosis or scarring of the kidneys. […] According to the FDA, Finerenone is effective at reducing the risk of: Kidney function decline, Kidney failure, Hospitalization for heart failure. […] If you have diabetes and kidney disease or early-stage kidney disease without diabetes, ask your doctor if you could benefit from any of these medications. […] If you have CKD with or without type 2 diabetes, ask if SGLT2 inhibitors are right for me. […] If you have CKD with type-2 diabetes, also ask if Finerenone, or GLP-1 receptor agonists, are right for me.

• #2 New Medications for Type 2 Diabetes and Kidney Disease: SGLT2 Inhibitors, Finerenone, and GLP-1 RA | National Kidney Foundation

  https://www.kidney.org/news-stories/game-changing-medications-kidney-disease-and-type-2-diabetes

  Before the existence of three new medications designed to help individuals with type 2 diabetes and kidney disease or early-stage kidney disease, we only had ACE inhibitors and angiotensin II receptor blockers that were kidney protective and managed blood pressure. Now we have SGLT2 inhibitors and Finerenone which are also kidney protective. […] „The SGLT-2 inhibitors or Flozins that have been shown in randomized clinical trials to reduce the risk of kidney failure by about 30 to 40%,” said Dr. Vassalotti, NKF’s Chief Medical Officer. „They also reduce the risk of heart failure hospitalization and death, so, these are really powerful medications and a new tool to treat people living with kidney disease to prevent kidney failure and reduce complications.” […] SGLT2 inhibitors are FDA-approved to help lower blood sugar in adults with type 2 diabetes and people with kidney disease with an eGFR as low as 20 (CKD stage 4). They may also protect the kidney function of people with early kidney disease who do not have diabetes but have albumin, a type of protein, in the urine.

• #2 Therapeutic Advances in Diabetic Nephropathy

  https://www.mdpi.com/2077-0383/11/2/378

  This review discusses the current landscape of treatment options for DKD, including an RAAS blockade with ACE-I or ARB, and newer therapies such as sodium-glucose transport protein 2 (SGLT2) inhibitors, endothelin antagonists, glucagon-like peptide-1 (GLP-1) agonists, and mineralocorticoid receptor antagonists (MRA), along with a summary of landmark trials that support the use of these agents. […] ACE-Is and ARBs have been well described in the literature, with landmark trials proving the therapeutic utility of this class of drugs for patients with DKD, and remain the mainstay of management of DKD. […] The beneficial effect of this class of medications are now known to go beyond their glucosuric effect, with independent cardiovascular and kidney benefits. […] Numerous trials have now established the cardiovascular and kidney benefits of SGLT2 inhibitors, and solidified their role in the management of patients with DKD and, most recently, proteinuric CKD in general.

• #2 Diabetic nephropathy (kidney disease) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetic-nephropathy/diagnosis-treatment/drc-20354562

  Finerenone (Kerendia) might help reduce tissue scarring in diabetic nephropathy. […] During kidney transplant surgery, the donor kidney is placed in the lower abdomen. […] For kidney failure, also called end-stage kidney disease, treatment focuses on either replacing the work of your kidneys or making you more comfortable. […] Options include: Kidney dialysis. […] Sometimes, a kidney transplant or a kidney-pancreas transplant is the best treatment choice for kidney failure. […] In the future, people with diabetic nephropathy may benefit from treatments being developed using techniques that help the body repair itself, called regenerative medicine. […] These techniques may help reverse or slow kidney damage.

• #2 Therapeutic Advances in Diabetic Nephropathy

  https://www.mdpi.com/2077-0383/11/2/378

  GLP-1 has also shown to have numerous kidney protective effects, including the inhibition of the inflammatory effects of angiotensin II and the inhibition of oxidative stress and albuminuria, as well as an ability to ameliorate albuminuria, glomerular hyperfiltration, glomerular hypertrophy and mesangial matrix expansion in animal models. […] Finerenone is a welcome addition to our armamentarium, promising the same benefits of steroidal MRAs, but with less side effects. […] Given the role various inflammatory pathways have been shown to play in the progression of DKD, pharmacologic intervention targeting these pathways have been areas of interest for potential treatment approaches. […] The future of DKD management has the potential to include a more personalized approach, where each patient can have a tailored treatment regimen based on their genetic and biomarker profile. […] These expanded therapeutic options have ushered in a new era of DKD management, enabling, cardiovascular, kidney, and survival benefits.

• #2 Diabetic nephropathy (kidney disease) | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/diabetic-nephropathy-kidney-disease

  Medicines called angiotensin-converting enzyme (ACE) inhibitors and angiotensin 2 receptor blockers (ARBs) are used to treat high blood pressure. […] Medicines can help control high blood sugar in people with diabetic nephropathy. […] Cholesterol-lowering drugs called statins are used to treat high cholesterol and lower the amount of protein in urine. […] Finerenone (Kerendia) might help reduce tissue scarring in diabetic nephropathy. […] For kidney failure, also called end-stage kidney disease, treatment focuses on either replacing the work of your kidneys or making you more comfortable. Options include: […] Kidney dialysis. This treatment removes waste products and extra fluid from the blood. […] Sometimes, a kidney transplant or a kidney-pancreas transplant is the best treatment choice for kidney failure. […] In the future, people with diabetic nephropathy may benefit from treatments being developed using techniques that help the body repair itself, called regenerative medicine.

• #2 Diabetic Kidney Disease: Diagnosis, Treatment, and Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0615/p751.html

  Identification of patients with microalbuminuria allows for timely initiation of treatment to prevent disease progression and to reduce the risk of ESRD. Treatment of DKD primarily involves careful management of hyperglycemia and hypertension with use of medications that confer specific renal benefit. […] Hyperglycemia should be managed with a multifactorial approach, including weight loss, exercise, diet modification, and medication. Lifestyle changes and metformin remain the first-line therapy for patients with diabetes. […] Notably, glucagon-like peptide-1 receptor agonists and dipeptidyl-peptidase-4 inhibitors reduce progression of albuminuria, and sodium-glucose cotransporter-2 inhibitors decrease rates of progression of renal disease and need for renal replacement therapy. […] Blood pressure (BP) control is critical to prevent and slow the progression of DKD.

• #2 Pillars of Diabetic Kidney Disease Treatment – Renal and Urology News

  https://www.renalandurologynews.com/features/diabetic-kidney-disease-treatment/

  When it comes to kidney protection, all 3 recently approved drug classes target inflammation and fibrosis in the kidney. SGLT2i (eg, dapagliflozin, empagliflozin, canagliflozin) and GLP1-RA (eg, semaglutide, liraglutide, and dulaglutide), also treat metabolic abnormalities of DKD. SGLT2i and the nonsteroidal MRA finerenone also target hemodynamic abnormalities. […] Given early evidence of additive benefit when using [guideline-directed medical therapy] in combination, a 4 pillar strategy has been proposed to maximize risk reduction in patients with cardiokidney-metabolic conditions, according to Dr Tuttle, who is also professor of medicine at the University of Washington, and colleagues. […] The 2022 guidelines from the Kidney Disease Improving Global Outcomes (KDIGO) organization provided a holistic approach to improving outcomes in patients with diabetes and CKD:

• #2 Diabetic nephropathy – Wikipedia

  https://en.wikipedia.org/wiki/Diabetic_nephropathy

  RAAS inhibition has been proven to be the most effective therapy to slow the progression of diabetic nephropathy in all stages. […] About half of insulin is metabolized and cleared by the kidneys. This means that as kidney function worsens in the setting of DN, some patients with insulin-dependent DM may find that their regular insulin doses are lasting longer than normal, or that they are experiencing an increasing frequency of hypoglycemic episodes. […] Some evidence suggests that limiting dietary protein could slow the progression of DN, but further evidence is needed to confirm this benefit. […] Patients with diabetic nephropathy might go on to develop end stage renal disease and require kidney transplantation or hemodialysis. […] A relatively new medication that has been approved for treatment for DM is sodium glucose cotransporter 2 (SGLT2) inhibitors. […] Other classes of diabetic medications that have been shown to have a positive effect on the progression of diabetic nephropathy are GLP-1 agonists and DPP-4 inhibitors.

• #2 Diabetic Nephropathy – Genitourinary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/genitourinary-disorders/glomerular-disorders/diabetic-nephropathy

  Dyslipidemia should also be treated. […] Statins should be used as first-line therapy for dyslipidemia treatment in patients with diabetic nephropathy because they reduce cardiovascular mortality and urinary protein. […] Kidney transplantation with or without simultaneous or subsequent pancreas transplantation is an option for patients with kidney failure. […] Treat blood pressure aggressively, usually beginning with angiotensin inhibition. […] Treat increased albuminuria with angiotensin inhibition. […] Control glucose to maintain HbA1C at 7.0. […] Treat dyslipidemia with a statin.

• #2 Management of diabetes mellitus in patients with chronic kidney disease | Cardiovascular Diabetology – Endocrinology Reports | Full Text

  https://clindiabetesendo.biomedcentral.com/articles/10.1186/s40842-015-0001-9

  Glycemic control is essential to delay or prevent the onset of diabetic kidney disease. […] Diabetes control should be optimized for each individual patient, with measures to reduce diabetes-related complications and minimize adverse events. […] Screening for diabetic nephropathy along with early intervention is fundamental to delaying its progression in conjunction with providing proper glycemic control. […] Knowledge regarding the prevention and management of diabetic nephropathy, along with other aspects of diabetes care, is part of the comprehensive care of any patient with diabetes. […] Glycemic control is essential to delay the onset of complications from diabetes, and it can be challenging for even the most experienced physician. […] Glycemic control is essential to delay or possibly prevent nephropathy.

• #2 Management of diabetes mellitus in patients with chronic kidney disease | Cardiovascular Diabetology – Endocrinology Reports | Full Text

  https://clindiabetesendo.biomedcentral.com/articles/10.1186/s40842-015-0001-9

  The data clearly show that lowering A1c leads to benefit in regards to nephropathy. […] The management of patients with diabetes and nephropathy necessitates attention to several aspects of care. Importantly, glycemic control should be optimized for the patient, attaining the necessary control to reduce complications but done in a safe, monitored manner. […] Prevention and treatment of diabetic nephropathy and other complications necessitates a multifactorial approach through the use of a diabetologist, nephrologist, dietician, diabetes educator and additional specialists experienced in the complications of diabetes to provide a multifaceted care program to reduce progression of disease.

• #2 Patient education: Diabetic kidney disease (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/diabetic-kidney-disease-beyond-the-basics/print

  In rare cases, you can have more serious side effects with ACE inhibitors and ARBs. These include a condition called hyperkalemia, in which too much potassium accumulates in the blood. To monitor for these and other side effects, health care providers sometimes run blood tests soon after starting these drugs. In some people, the medications will need to be stopped. […] SGLT2 inhibitors — In addition to the measures described above, some people with type 2 diabetes and kidney disease will get a medication called a sodium-glucose cotransporter 2 (SGLT2) inhibitor. These medications lower blood sugar by increasing the excretion of sugar in the urine in people with good kidney function; they include canagliflozin (brand name: Invokana), empagliflozin (brand name: Jardiance), and dapagliflozin (brand name: Farxiga).

• #2 Patient education: Diabetic kidney disease (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/diabetic-kidney-disease-beyond-the-basics/print

  Managing high blood pressure — Many people with diabetes have hypertension (high blood pressure). Although high blood pressure causes few symptoms, it has two negative effects: it stresses the cardiovascular system and speeds the development of diabetic complications of the kidney and eye. A health care provider can diagnose high blood pressure by measuring blood pressure on a regular basis. (See „Patient education: High blood pressure in adults (Beyond the Basics)”.) […] The treatment of high blood pressure varies. If you have mild hypertension, your health care provider may recommend weight loss, exercise, decreasing the amount of salt in the diet, quitting smoking, and decreasing alcohol intake. These measures can sometimes reduce blood pressure to normal. (See „Patient education: High blood pressure, diet, and weight (Beyond the Basics)”.)

• #2 Diabetic Nephropathy – Genitourinary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/genitourinary-disorders/glomerular-disorders/diabetic-nephropathy

  Diabetic nephropathy is glomerular sclerosis and fibrosis caused by the metabolic and hemodynamic changes of diabetes mellitus. […] Treatment is strict glucose control, angiotensin inhibition (using angiotensin-converting enzyme [ACE] inhibitors or angiotensin II receptor blockers [ARBs]), and control of blood pressure and lipids. […] Primary treatment is strict glucose control to maintain HbA1C 7.0; maintenance of euglycemia reduces microalbuminuria but may not retard disease progression once diabetic nephropathy is well-established. […] Glucose control must also be accompanied by strict control of BP to 130/80 mm Hg, although some experts recommend BP 140/90 mm Hg. […] Angiotensin inhibition is first-line therapy. Thus, angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) are the antihypertensives of choice; they reduce BP and proteinuria and slow the progression of diabetic nephropathy.

• #2 Diabetic nephropathy services – Overview – Mayo Clinic

  https://www.mayoclinic.org/departments-centers/diabetic-nephropathy-clinic/overview/ovc-20464936

  Medication review and dosage adjustment or change, to minimize or prevent side effects […] Medication counseling about drugs that could cause further kidney damage, such as nonsteroidal anti-inflammatory drugs and iodine contrast agents, which are used for angiogram studies and CT scans. […] Mayo Clinic physicians and scientists are committed to conducting research into the causes of diabetic nephropathy and new therapies to treat it. Talk with your doctor about opportunities to participate in Mayo Clinic clinical trials testing new therapies for diabetic nephropathy.

• #2 Diabetic nephropathy: Symptoms, stages, causes, and treatment

  https://www.medicalnewstoday.com/articles/319686

  If diabetic nephropathy progresses to ESRD, a person will need either dialysis or a kidney transplant. […] Kidney dialysis is a procedure that typically uses a machine to separate waste products from the blood and remove them from the body. […] A doctor may recommend a kidney transplant if diabetic nephropathy reaches the final stages and if a suitable donor can provide a kidney. […] The outlook for people with diabetic nephropathy will depend on how well they manage their blood sugar and blood pressure levels and the stage at which they receive a diagnosis. The earlier treatment starts, the better the outlook. […] Treatment can delay or prevent the progress of diabetic nephropathy.

• #2 Diabetic Nephropathy: Symptoms, Outlook, and More

  https://www.healthline.com/health/type-2-diabetes/nephropathy

  If you have ESRD, you will likely need dialysis or a kidney transplant, in addition to treatments for earlier stages of kidney disease. […] Dialysis is a procedure that helps to filter the waste out of your blood. There are two main types of dialysis: hemodialysis and peritoneal dialysis. Your doctor will help you decide which is best for you. […] Following a treatment plan and making recommended lifestyle changes can slow the diseases progression and keep your kidneys healthy longer.

• #2 Diabetic Nephropathy: Causes, Symptoms, Treatment, Outlook, and More

  https://www.verywellhealth.com/diabetic-nephropathy-8665334

  People with diabetic nephropathy need to follow a diet that is healthy for their diabetes but also their kidneys. The following eating patterns may be beneficial: Avoiding foods high in sugar and processed carbohydrates (e.g., cookies and soft drinks); Eating a diet with whole-grain carbohydrates and fiber, like from oatmeal and fresh fruits and vegetables; Eating foods high in omega-3 fatty acids, such as fish like salmon; Limiting protein (especially from proteins high in saturated fats, like beef or other animal source); Limiting sodium to 2,300 mg per day or less. […] People with end-stage (stage 5) kidney failure from diabetes will die of the condition unless they are treated with dialysis or a kidney transplant. […] The majority of people with end-stage kidney disease go on dialysis. In this approach, you are connected to a machine that cleans your blood similar to how your kidneys would have done. […] Some people with diabetic nephropathy can get a kidney transplant. In some cases, healthcare providers combine a kidney transplant with a pancreas transplant to treat diabetes directly.

• #3 Diabetic nephropathy (kidney disease) | Diabetes UK

  https://www.diabetes.org.uk/about-diabetes/looking-after-diabetes/complications/kidneys-nephropathy

  Diabetic nephropathy is the name given to kidney damage caused by diabetes. […] Diabetic kidney disease is another name given to diabetic nephropathy. […] With the right support you can reduce your risk of developing this complication. […] if its spotted early enough, diabetic nephropathy can be slowed down with certain treatment. […] What is the treatment for diabetic kidney disease? […] Almost one in five people with diabetes will need treatment for diabetic nephropathy. The type of treatment you need will depend on the stage of your kidney disease: […] Keeping your blood pressure at your target level can help stop kidney disease from getting worse. […] Your doctor may offer you tablets to help with this, such as ACE inhibitors and ARBs. […] Both ACE inhibitors and ARBs help to protect the kidneys from further damage, as well as lower blood pressure.

• #3 Diabetic nephropathy: Symptoms, stages, causes, and treatment

  https://www.medicalnewstoday.com/articles/319686

  The main aim of treatment is to maintain and control blood glucose levels and blood pressure. This may involve the use of medication. […] Angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) can help lower blood pressure, protect kidney function, and prevent further damage. […] Kerendia (finerenone) is a prescription medicine that can reduce the risk of sustained GFR decline, end-stage kidney disease, cardiovascular death, nonfatal myocardial infarction, and hospitalization for heart failure in adults with CKD associated with type 2 diabetes. […] In 2018, the American College of Cardiology issued guidelines recommending the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors or glucagon-like peptide-1 receptor agonists (GLP-1RAs) for people with type 2 diabetes and CKD. These drugs may reduce the risk of CKD progression, cardiovascular events, or both.

Zobacz więcej