open access

Vol 9, No 3 (2020)
REVIEW ARTICLES
Published online: 2020-06-02
Get Citation

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

Hanna Kwiendacz, Katarzyna Nabrdalik, Janusz Gumprecht
DOI: 10.5603/DK.2020.0019
·
Clinical Diabetology 2020;9(3):184-188.

open access

Vol 9, No 3 (2020)
REVIEW ARTICLES
Published online: 2020-06-02

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.

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.
Get Citation

Keywords

diabetes mellitus, diabetic kidney disease, microangiopathy

About this article
Title

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

Journal

Clinical Diabetology

Issue

Vol 9, No 3 (2020)

Pages

184-188

Published online

2020-06-02

DOI

10.5603/DK.2020.0019

Bibliographic record

Clinical Diabetology 2020;9(3):184-188.

Keywords

diabetes mellitus
diabetic kidney disease
microangiopathy

Authors

Hanna Kwiendacz
Katarzyna Nabrdalik
Janusz Gumprecht

References (53)
  1. Saran R, Robinson B, Abbott K, et al. US Renal Data System 2019 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. 2020; 75(1): A6–A7.
  2. Kramer A, Pippias M, Noordzij M, et al. The European Renal Association - European Dialysis and Transplant Association (ERA-EDTA) Registry Annual Report 2015: a summary. Clin Kidney J. 2018; 11(1): 108–122.
  3. Reutens AT. Epidemiology of diabetic kidney disease. Med Clin North Am. 2013; 97(1): 1–18.
  4. Ginter E, Simko V. Type 2 diabetes mellitus, pandemic in 21st century. Adv Exp Med Biol. 2012; 771: 42–50.
  5. Cho NH, Shaw JE, Karuranga S, et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018; 138: 271–281.
  6. Adler AI, Stevens RJ, Manley SE, et al. UKPDS GROUP. Development and progression of nephropathy in type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney Int. 2003; 63(1): 225–232.
  7. MacIsaac RJ, Panagiotopoulos S, McNeil KJ, et al. Is nonalbuminuric renal insufficiency in type 2 diabetes related to an increase in intrarenal vascular disease? Diabetes Care. 2006; 29(7): 1560–1566.
  8. Orchard TJ, Secrest AM, Miller RG, et al. In the absence of renal disease, 20 year mortality risk in type 1 diabetes is comparable to that of the general population: a report from the Pittsburgh Epidemiology of Diabetes Complications Study. Diabetologia. 2010; 53(11): 2312–2319.
  9. Afkarian M, Sachs MC, Kestenbaum B, et al. Kidney disease and increased mortality risk in type 2 diabetes. J Am Soc Nephrol. 2013; 24(2): 302–308.
  10. Stephens JW, Brown KE, Min T. Chronic kidney disease in type 2 diabetes: Implications for managing glycaemic control, cardiovascular and renal risk. Diabetes Obes Metab. 2020; 22 Suppl 1: 32–45.
  11. Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes − 2020. Diabetes Care. 2019; 43(Supplement 1): S135–S151.
  12. Lamb EJ, Levey AS, Stevens PE. The Kidney Disease Improving Global Outcomes (KDIGO) guideline update for chronic kidney disease: evolution not revolution. Clin Chem. 2013; 59(3): 462–465.
  13. Levey AS, Stevens LA, Schmid CH, et al. CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009; 150(9): 604–612.
  14. Stevens PE, Levin A. Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 2013; 158(11): 825–830.
  15. Dwyer JP, Parving HH, Hunsicker LG, et al. Renal Dysfunction in the Presence of Normoalbuminuria in Type 2 Diabetes: Results from the DEMAND Study. Cardiorenal Med. 2012; 2(1): 1–10.
  16. Kramer HJ, Nguyen QD, Curhan G, et al. Renal insufficiency in the absence of albuminuria and retinopathy among adults with type 2 diabetes mellitus. JAMA. 2003; 289(24): 3273–3277.
  17. Penno G, Solini A, Bonora E, et al. Renal Insufficiency And Cardiovascular Events (RIACE) Study Group. Clinical significance of nonalbuminuric renal impairment in type 2 diabetes. J Hypertens. 2011; 29(9): 1802–1809.
  18. Thomas MC, Macisaac RJ, Jerums G, et al. Nonalbuminuric renal impairment in type 2 diabetic patients and in the general population (national evaluation of the frequency of renal impairment cO-existing with NIDDM [NEFRON] 11). Diabetes Care. 2009; 32(8): 1497–1502.
  19. Thorn LM, Gordin D, Harjutsalo V, et al. FinnDiane Study Group. The presence and consequence of nonalbuminuric chronic kidney disease in patients with type 1 diabetes. Diabetes Care. 2015; 38(11): 2128–2133.
  20. Penno G, Russo E, Garofolo M, et al. Evidence for two distinct phenotypes of chronic kidney disease in individuals with type 1 diabetes mellitus. Diabetologia. 2017; 60(6): 1102–1113.
  21. Pacilli A, Viazzi F, Fioretto P, et al. AMD-Annals Study Group. Epidemiology of diabetic kidney disease in adult patients with type 1 diabetes in Italy: The AMD-Annals initiative. Diabetes Metab Res Rev. 2017; 33(4).
  22. Lamacchia O, Viazzi F, Fioretto P, et al. Normoalbuminuric kidney impairment in patients with T1DM: insights from annals initiative. Diabetol Metab Syndr. 2018; 10: 60.
  23. Afkarian M, Zelnick LR, Hall YN, et al. Clinical Manifestations of Kidney Disease Among US Adults With Diabetes, 1988-2014. JAMA. 2016; 316(6): 602–610.
  24. Gregg EW, Li Y, Wang J, et al. Changes in diabetes-related complications in the United States, 1990–2010. N Engl J Med. 2014; 370(16): 1514–1523.
  25. Bello AK, Levin A, Tonelli M, et al. Assessment of global kidney health care status. JAMA. 2017; 317(18): 1864–1881.
  26. Saran R, Robinson B, Abbott KC, et al. US Renal Data System 2016 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. 2017; 69(3 Suppl 1): A7–A8.
  27. Hill NR, Fatoba ST, Oke JL, et al. Global prevalence of chronic kidney disease - a systematic review and meta-analysis. PLoS One. 2016; 11(7): e0158765.
  28. Fiorentino M, Bolignano D, Tesar V, et al. ERA-EDTA Immunonephrology Working Group. Renal biopsy in patients with diabetes: a pooled meta-analysis of 48 studies. Nephrol Dial Transplant. 2017; 32(1): 97–110.
  29. Sharma SG, Bomback AS, Radhakrishnan J, et al. The modern spectrum of renal biopsy findings in patients with diabetes. Clin J Am Soc Nephrol. 2013; 8(10): 1718–1724.
  30. Pippias M, Kramer A, Noordzij M, et al. The European Renal Association - European Dialysis and Transplant Association Registry Annual Report 2014: a summary. Clin Kidney J. 2017;10(2):154-69. DOI: 10.1093/ckj/sfx149.
  31. Ninomiya T, Perkovic V, de Galan BE, et al. ADVANCE Collaborative Group. Albuminuria and kidney function independently predict cardiovascular and renal outcomes in diabetes. J Am Soc Nephrol. 2009; 20(8): 1813–1821.
  32. Gaede P, Vedel P, Larsen N, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003; 348(5): 383–393.
  33. Gaede P, Lund-Andersen H, Parving HH, et al. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med. 2008; 358(6): 580–591.
  34. Oellgaard J, Gæde P, Rossing P, et al. Intensified multifactorial intervention in type 2 diabetics with microalbuminuria leads to long-term renal benefits. Kidney Int. 2017; 91(4): 982–988.
  35. Brenner BM, Cooper ME, de Zeeuw D, et al. RENAAL Study Investigators. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med. 2001; 345(12): 861–869.
  36. Wu HY, Huang JW, Lin HJ, et al. Comparative effectiveness of renin-angiotensin system blockers and other antihypertensive drugs in patients with diabetes: systematic review and bayesian network meta-analysis. BMJ. 2013; 347: f6008.
  37. Rosolowsky ET, Skupien J, Smiles AM, et al. Risk for ESRD in type 1 diabetes remains high despite renoprotection. J Am Soc Nephrol. 2011;22(3):545-53. DOI: 10.1136/bmj.f6008.
  38. Wanner C, Inzucchi SE, Lachin JM, et al. EMPA-REG OUTCOME Investigators. Empagliflozin and progression of kidney disease in type 2 diabetes. N Engl J Med. 2016; 375(4): 323–334.
  39. Neal B, Perkovic V, Mahaffey KW, et al. CANVAS Program Collaborative Group. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017; 377(7): 644–657.
  40. Wiviott SD, Raz I, Bonaca MP, et al. DECLARE–TIMI 58 Investigators. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2019; 380(4): 347–357.
  41. Marso SP, Daniels GH, Brown-Frandsen K, et al. LEADER Steering Committee, LEADER Trial Investigators. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016; 375(4): 311–322.
  42. Marso SP, Bain SC, Consoli A, et al. SUSTAIN-6 Investigators. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016; 375(19): 1834–1844.
  43. Husain M, Birkenfeld AL, Donsmark M, et al. PIONEER 6 Investigators. Oral semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2019; 381(9): 841–851.
  44. Gerstein HC, Colhoun HM, Dagenais GR, et al. REWIND Investigators. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. Lancet. 2019; 394(10193): 121–130.
  45. Heerspink HJL, Stefansson BV, Chertow GM, et al. DAPA-CKD Investigators. Rationale and protocol of the Dapagliflozin And Prevention of Adverse outcomes in Chronic Kidney Disease (DAPA-CKD) randomized controlled trial. Nephrol Dial Transplant. 2020; 35(2): 274–282.
  46. Herrington WG, Preiss D, Haynes R, et al. The potential for improving cardio-renal outcomes by sodium-glucose co-transporter-2 inhibition in people with chronic kidney disease: a rationale for the EMPA-KIDNEY study. Clin Kidney J. 2018; 11(6): 749–761.
  47. Perkovic V, Jardine MJ, Neal B, et al. CREDENCE Trial Investigators. Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. N Engl J Med. 2019; 380(24): 2295–2306.
  48. Canagliflozin – Center for Drug Evaluation and Research https://www.accessdata.fda.gov/drugsatfda_docs/nda/2019/204042Orig1s032Approv.pdf accessed 30.04.2020.
  49. A Research Study to See How Semaglutide Works Compared to Placebo in People With Type 2 Diabetes and Chronic Kidney Disease (FLOW) – clinical trials. https://clinicaltrials.gov/ct2/show/NCT03819153. accessed 30.04.2020.
  50. Davies MJ, D'Alessio DA, Fradkin J, et al. Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2018; 41(12): 2669–2701.
  51. Gaede P, Vedel P, Parving HH, et al. Intensified multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: the Steno type 2 randomised study. Lancet. 1999; 353(9153): 617–622.
  52. Buse JB, Wexler DJ, Tsapas A, et al. 2019 update to: Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2020; 63(2): 221–228.
  53. 2020 Guidelines on the management of diabetic patients. A position of Diabetes Poland. Clinical Diabetology 2020;9(1):1-101. https://journals.viamedica.pl/clinical_diabetology/article/view/68503 Accessed 30.04.2020.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

 

Wydawcą serwisu jest  "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl