Diabetic kidney disease — state-of-the-art knowledge in 2020

Abstract

Diabetic kidney disease is one of the most common complications of diabetes. For many years, it has also been the most common cause of end stage renal disease. The diagnosis of DKD is based on determining the urinary albumin-to-creatinine ratio and calculating the estimated glomerular filtration rate. Recently, the disease phenotype has changed and instead of the classical diabetic kidney disease presentation characterized by albuminuria followed by progressive renal failure, patients nowadays more often present only with reduced eGFR but normal urinary albumin excretion. The nephroprotective properties of new antidiabetic drugs, such as sodium-glucose co-transporter-2 inhibitors and glucagon-like peptide-1 analogues, are the novelty of recent years. Moreover, there are ongoing outcome trials with renal safety as the primary endpoint, and their results may extend the knowledge about using antidiabetic drugs for renal risk reduction not only in patients with diabetes but also in those without carbohydrate metabolism disorders.