Thank you Dr. Nataraj, Dr. Maiya, and Dr. Nagaraju for your response.

Although we have focused on US guidelines surrounding chronic kidney disease (CKD) in people with type 2 diabetes mellitus, this is clearly a global issue. We recognize that the standard of care in the USA may differ from other countries. The goal of frequent kidney function screening in people with diabetes is to prevent patients from presenting with gross symptoms of CKD as in the example given.

We agree that prevention is key. We look forward to learning more about the role of exercise in CKD prevention as further research develops. The guidelines we presented and medications described to help prevent and slow progression of CKD are reliant on access to resources in the community. Unfortunately, there are many obstacles including costs, access to specialists, health literacy, and patient non-adherence. However, we must advocate for our patients to prevent the long-term consequences of CKD.