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Diabetic kidney disease: a clinical update from Kidney Disease: Improving Global Outcomes.

Molitch ME, Adler AI, Flyvbjerg A, Nelson RG, So WY, Wanner C, Kasiske BL, Wheeler DC, de Zeeuw D, Mogensen CE - Kidney Int. (2014)

Bottom Line: The incidence and prevalence of diabetes mellitus (DM) continue to grow markedly throughout the world, due primarily to the increase in type 2 DM (T2DM).Although improvements in DM and hypertension management have reduced the proportion of diabetic individuals who develop chronic kidney disease (CKD) and progress to end-stage renal disease (ESRD), the sheer increase in people developing DM will have a major impact on dialysis and transplant needs.This KDIGO conference addressed a number of controversial areas in the management of DM patients with CKD, including aspects of screening for CKD with measurements of albuminuria and estimated glomerular filtration rate (eGFR); defining treatment outcomes; glycemic management in both those developing CKD and those with ESRD; hypertension goals and management, including blockers of the renin-angiotensin-aldosterone system; and lipid management.

View Article: PubMed Central - PubMed

Affiliation: Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.

ABSTRACT
The incidence and prevalence of diabetes mellitus (DM) continue to grow markedly throughout the world, due primarily to the increase in type 2 DM (T2DM). Although improvements in DM and hypertension management have reduced the proportion of diabetic individuals who develop chronic kidney disease (CKD) and progress to end-stage renal disease (ESRD), the sheer increase in people developing DM will have a major impact on dialysis and transplant needs. This KDIGO conference addressed a number of controversial areas in the management of DM patients with CKD, including aspects of screening for CKD with measurements of albuminuria and estimated glomerular filtration rate (eGFR); defining treatment outcomes; glycemic management in both those developing CKD and those with ESRD; hypertension goals and management, including blockers of the renin-angiotensin-aldosterone system; and lipid management.

No MeSH data available.


Related in: MedlinePlus

Approaches to improving outcomes related to diabetic kidney disease.The best approach to prevent diabetic kidney disease is to prevent the diabetes itself. However, once diabetes occurs glycemic control may prevent/delay the development of diabetic kidney disease. In those patient who develop diabetic kidney disease, glycemic control, blood pressure control, and RAAS inhibition are all important in delaying/decreasing progression to ESRD and glycemic control, blood pressure control, and lipid management are all important in delaying/decreasing the development of CVD. CVD, cardiovascular disease; ESRD, end-stage renal disease; RAAS, renin-angiotensin-aldosterone system. White arrows denote potential preventive measures.
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Figure 1: Approaches to improving outcomes related to diabetic kidney disease.The best approach to prevent diabetic kidney disease is to prevent the diabetes itself. However, once diabetes occurs glycemic control may prevent/delay the development of diabetic kidney disease. In those patient who develop diabetic kidney disease, glycemic control, blood pressure control, and RAAS inhibition are all important in delaying/decreasing progression to ESRD and glycemic control, blood pressure control, and lipid management are all important in delaying/decreasing the development of CVD. CVD, cardiovascular disease; ESRD, end-stage renal disease; RAAS, renin-angiotensin-aldosterone system. White arrows denote potential preventive measures.

Mentions: As this conference clearly demonstrated, the goal of improving outcomes related to DKD involves a coordinated and multipronged approach to tackle its comorbidities (Figure 1). The optimal management of DKD has proved challenging but we have made great strides, with the number of patients developing ESRD per 100,000 patients with DM expected to decline considerably over the next decade. New drugs continue to be developed with novel mechanisms of action so that a continued exploration of the basic pathophysiology of DKD becomes ever more important. It may well be that some subgroups of patients respond better to one drug than another and better methods of identifying such subgroups will be of clinical benefit and provide us with a better understanding of the pathophysiology.


Diabetic kidney disease: a clinical update from Kidney Disease: Improving Global Outcomes.

Molitch ME, Adler AI, Flyvbjerg A, Nelson RG, So WY, Wanner C, Kasiske BL, Wheeler DC, de Zeeuw D, Mogensen CE - Kidney Int. (2014)

Approaches to improving outcomes related to diabetic kidney disease.The best approach to prevent diabetic kidney disease is to prevent the diabetes itself. However, once diabetes occurs glycemic control may prevent/delay the development of diabetic kidney disease. In those patient who develop diabetic kidney disease, glycemic control, blood pressure control, and RAAS inhibition are all important in delaying/decreasing progression to ESRD and glycemic control, blood pressure control, and lipid management are all important in delaying/decreasing the development of CVD. CVD, cardiovascular disease; ESRD, end-stage renal disease; RAAS, renin-angiotensin-aldosterone system. White arrows denote potential preventive measures.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4214898&req=5

Figure 1: Approaches to improving outcomes related to diabetic kidney disease.The best approach to prevent diabetic kidney disease is to prevent the diabetes itself. However, once diabetes occurs glycemic control may prevent/delay the development of diabetic kidney disease. In those patient who develop diabetic kidney disease, glycemic control, blood pressure control, and RAAS inhibition are all important in delaying/decreasing progression to ESRD and glycemic control, blood pressure control, and lipid management are all important in delaying/decreasing the development of CVD. CVD, cardiovascular disease; ESRD, end-stage renal disease; RAAS, renin-angiotensin-aldosterone system. White arrows denote potential preventive measures.
Mentions: As this conference clearly demonstrated, the goal of improving outcomes related to DKD involves a coordinated and multipronged approach to tackle its comorbidities (Figure 1). The optimal management of DKD has proved challenging but we have made great strides, with the number of patients developing ESRD per 100,000 patients with DM expected to decline considerably over the next decade. New drugs continue to be developed with novel mechanisms of action so that a continued exploration of the basic pathophysiology of DKD becomes ever more important. It may well be that some subgroups of patients respond better to one drug than another and better methods of identifying such subgroups will be of clinical benefit and provide us with a better understanding of the pathophysiology.

Bottom Line: The incidence and prevalence of diabetes mellitus (DM) continue to grow markedly throughout the world, due primarily to the increase in type 2 DM (T2DM).Although improvements in DM and hypertension management have reduced the proportion of diabetic individuals who develop chronic kidney disease (CKD) and progress to end-stage renal disease (ESRD), the sheer increase in people developing DM will have a major impact on dialysis and transplant needs.This KDIGO conference addressed a number of controversial areas in the management of DM patients with CKD, including aspects of screening for CKD with measurements of albuminuria and estimated glomerular filtration rate (eGFR); defining treatment outcomes; glycemic management in both those developing CKD and those with ESRD; hypertension goals and management, including blockers of the renin-angiotensin-aldosterone system; and lipid management.

View Article: PubMed Central - PubMed

Affiliation: Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.

ABSTRACT
The incidence and prevalence of diabetes mellitus (DM) continue to grow markedly throughout the world, due primarily to the increase in type 2 DM (T2DM). Although improvements in DM and hypertension management have reduced the proportion of diabetic individuals who develop chronic kidney disease (CKD) and progress to end-stage renal disease (ESRD), the sheer increase in people developing DM will have a major impact on dialysis and transplant needs. This KDIGO conference addressed a number of controversial areas in the management of DM patients with CKD, including aspects of screening for CKD with measurements of albuminuria and estimated glomerular filtration rate (eGFR); defining treatment outcomes; glycemic management in both those developing CKD and those with ESRD; hypertension goals and management, including blockers of the renin-angiotensin-aldosterone system; and lipid management.

No MeSH data available.


Related in: MedlinePlus