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Feature Article

Chronic kidney disease and type 2 diabetes: a guide to screening, diagnosis and slowing progression

Richard J. MacIsaac, Elif I. Ekinci

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© CRYSTAL LIGHT/STOCK.ADOBE.COM
© CRYSTAL LIGHT/STOCK.ADOBE.COM

Abstract

It is important to screen for, diagnose and aggressively manage chronic kidney disease in people with type 2 diabetes because diabetic kidney disease is a major cause of morbidity and mortality. Progression of diabetic kidney disease can be delayed and prevented by aiming for tight glycaemic control and by using blockers of the renin-angiotensin system and, if appropriate, sodium-glucose cotransporter 2 inhibitors. It is also important to aggressively address cardiovascular risk factors.

Key Points

  • Diabetic kidney disease (DKD) can be screened for by measuring the albumin to creatinine ratio in an early morning spot urine collection and by measuring the serum creatinine level to allow for estimation of glomerular filtration rate.
  • Yearly screening for DKD should commence in patients at the time of their diagnosis of type 2 diabetes.
  • A diagnosis of DKD should be made if repeat testing confirms an elevated albumin to creatinine ratio (>2.5 mg/mmol in men or >3.5 mg/mmol in women) and/or the estimated glomerular filtration rate is less than 60 mL/min/1.73m2.
  • Progression of DKD can be delayed by aiming for good glycaemic (general HbA1c target <7% or 53 mmol/mol) and blood pressure (general target <140/90 mmHg) control. A tighter blood pressure target of less than 130/80 mmHg may be appropriate in patients with macroalbuminuria (proteinuria).
  • Blockers of the renin-angiotensin system at maximally tolerated doses and, if appropriate, sodium-glucose cotransporter-2 inhibitors can be used to slow the progression of DKD.
  • Cardiovascular risk factors should be treated aggressively in patients with DKD.

Figures

© CRYSTAL LIGHT/STOCK.ADOBE.COM
© CRYSTAL LIGHT/STOCK.ADOBE.COM