Post Date December, 03 2023
The incidence rate of diabetes is increasing year by year, and about 40% of diabetes patients will develop into chronic kidney disease (CKD). Diabetes has become the main cause of end-stage renal disease (ESKD) in developed countries. However, there are still many problems in the management of CKD patients with diabetes, and there is no professional guide. In February 2015, KDIGO organized experts from all over the world to develop a management guide for CKD patients with diabetes. This article will share the main content with you.
Lifestyle
Salt intake, obesity, sedentary, etc. are related to the incidence and mortality of diabetes kidney disease (DKD). Limiting salt intake can reduce blood pressure and urinary protein, while increasing the efficacy of renin angiotensin system inhibitors (RASi). Currently, the optimal daily salt intake for DKD patients is still controversial. At the same time, losing weight, exercising, and supplementing monounsaturated or polyunsaturated fatty acids are beneficial for controlling blood sugar, blood pressure, and urinary protein.
Blood glucose control
Intensive glycemic control remains controversial for the prognosis of kidney disease.
Hypoglycemic drugs
Patients with stable renal function can use low dose metformin (≤ 1 g/day); EGFR<30mL/min/1.73m2 can also be used, but the safety is still controversial. GLP-1 receptor agonists, DDP-4 inhibitors, and SGLT2 inhibitors all have renal protective effects independent of hypoglycemic effects.
Blood glucose monitoring
At present, the application of HbA1c, a long-term blood glucose monitoring index for diabetes patients, in CKD patients is controversial. Glycosylated albumin, glycosamine, or 1,5-anhydroglucitol may become alternative indicators.
Hypoglycemia
Hypoglycemia is associated with increased mortality in patients with CKD.
Dual RAS blocking
Double RAS blocking therapy significantly increased the incidence of adverse reactions such as hyperkalemia and acute renal damage.
Cardiovascular outcomes
Patients with DKD have a significantly increased risk of cardiovascular disease (CVD). Blood pressure and dyslipidemia are the main traditional risk factors for CVD. KDIGO's latest blood pressure and lipid management guidelines: patients with diabetes and proteinuria (urinary albumin/creatinine ratio>3mg/mmol or>30mg/g) were given a single dose of RAS blocker to control blood pressure to<130/80mmHg combined with medium dose statins.
Capacity control
The increase of insulin, RASi, SGLT2 cotransferrin activity and the decrease of GFR are the main factors leading to water and sodium retention in patients. However, the impact of volume overload on the incidence and mortality of CVD is unclear.
Blood lipid control
Lipid lowering drugs can safely reduce CVD events in CKD patients. Guideline recommendation: Medium dose statins, no need to adjust dose. Targeted therapies for lipoprotein abnormalities, low high-density lipoprotein cholesterol, and high triglycerides require further research.
Antiplatelet/thrombotic therapy
The use of antiplatelet and antithrombotic drugs to prevent CVD in patients with DKD or CKD has not been fully studied. Given the risks associated with the use of antiplatelet/antithrombotic drugs, it is important to identify when to use these drugs and which patients should use them. Atrial fibrillation is a common disease in patients with CKD and dialysis, but treatment with warfarin may increase the risk of bleeding, vascular calcification, and calcification defense.
Security
In patients with diabetes CKD, the risk of adverse drug reactions increases. Therefore, attention should be paid to drug safety when taking hypoglycemic drugs to control blood sugar.
