Kidney disease in patients with T2D is associated with reduced life expectancy and higher cardiovascular mortality rates. This module explores the pathophysiology of diabetic kidney disease, guideline recommendations for its prevention and management, and the potential for beneficial effects on kidney outcomes with SGLT2 inhibitor treatment.
Diabetic kidney disease
Contents
Definition of kidney disease
Guidelines recommend that kidney function is assessed based on glomerular filtration rate and albuminuria1
Stages of CKD are defined according to eGFR and degree of albuminuria
T2D constitutes an increasing global burden
Diabetes is a leading cause of end-stage kidney disease
Patients with DKD have the worst prognosis among patients with CKD and/or T2D
Progression of DKD is associated with increased mortality
Presence of CKD is commonly associated with the development of fatal CV comorbidities
Haemodynamic changes to either the heart or kidneys contribute to the dysfunction of the other
Contents
Kidney, nephron and glomerular apparatus:
Systemic effects of hyperglycaemia in T2D ultimately lead to nephron loss and progression of kidney disease
Contents
ADA consensus recommendations for DKD screening
A multifactorial intervention strategy can slow the progression of DKD1
Despite treating to goals, a significant residual risk of kidney disease progression remains
Contents
For two decades, no new treatments were identified for the treatment of DKD
Several strategies have since been explored in patients with DKD, with limited (or no) success
The effects of SGLT2 inhibitors on kidney outcomes in patients with T2D have been evaluated in CVOTs
Recently, the effects of SGLT2 inhibitors have been evaluated in a dedicated kidney outcomes trial in patients with DKD
The effects of GLP-1 receptor agonists on kidney outcomes in patients with T2D have also been evaluated in CVOTs
Both SGLT2 inhibitors and GLP-1 receptor agonists have shown kidney benefits with differing effects
CREDENCE was the first completed trial with kidney outcomes conducted in patients with T2D and albuminuric CKD
Global clinical guidelines and societies now recommend the preferential use of SGLT2 inhibitors in patients with CKD
Several studies are ongoing in a range of patients with CKD, with and without T2D
DAPA-CKD: trial design
DAPA-CKD: key inclusion and exclusion criteria
FIDELIO-DKD: trial design
FIDELIO-DKD: key inclusion and exclusion criteria
FIGARO-DKD: trial design
FIGARO-DKD: key inclusion and exclusion criteria
EMPA-KIDNEY: trial design
EMPA-KIDNEY: key inclusion and exclusion criteria
Summary
T2D has become an increasingly frequent cause of kidney disease
Hard kidney outcomes and albuminuria in completed CV, cardio–renal and HF trials in patients with T2D
Evidence from SGLT2 inhibitor and GLP-1 RA outcomes trials has led to major updates in clinical recommendations and guidelines
ADA guidelines have evolved to recommend SGLT2 inhibitors and GLP-1 RAs with proven CV and kidney benefits
New ADA guideline recommendations have been included for CV disease and kidney disease risk management in T2D
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