Diabetic kidney disease | ACROSS T2D

Diabetic kidney disease

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

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