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Diabetes and Kidney Disease: A Review of the Clinical Practice Guidelines

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Diabetes and Kidney Disease

Abstract

Diabetes and chronic kidney disease (CKD) are major cardiovascular risk factors. Appropriate and timely management of diabetes in those with CKD improves both cardiovascular disease and kidney disease progression. In this chapter, we discuss several aspects of diagnosis and treatment in patients with diabetes and CKD based on the evidence-based clinical practice guidelines issued by the Kidney Disease: Improving Global Outcomes, European Association for the Study of Diabetes in collaboration with the European Society of Cardiology, and American Diabetes Association. Specific importance has been given to the following areas that have direct clinical implications: (a) glycemic monitoring and targets, (b) use of antihyperglycemic therapies, (c) blood pressure control and comprehensive management, (d) lifestyle interventions, and (e) the importance of self-management and team-based care.

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References

  1. KDIGO. 2020 clinical practice guideline for diabetes Management in Chronic Kidney Disease. Kidney Int. 2020;98(4s):S1–s115.

    Google Scholar 

  2. Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: The Task Force for diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD). Eur Heart J. 2019;41(2):255–323.

    Article  Google Scholar 

  3. Introduction: Standards of Medical Care in Diabetes—2021. Diabetes Care. 2021;44(Supplement 1):S1–2.

    Google Scholar 

  4. de Boer IH. Kidney disease and related findings in the diabetes control and complications trial/epidemiology of diabetes interventions and complications study. Diabetes Care. 2014;37(1):24–30.

    Article  PubMed  CAS  Google Scholar 

  5. Laiteerapong N, Ham SA, Gao Y, Moffet HH, Liu JY, Huang ES, et al. The legacy effect in type 2 diabetes: impact of early glycemic control on future complications (The Diabetes & Aging Study). Diabetes Care. 2019;42(3):416–26.

    Article  CAS  PubMed  Google Scholar 

  6. Zoungas S, Arima H, Gerstein HC, Holman RR, Woodward M, Reaven P, et al. Effects of intensive glucose control on microvascular outcomes in patients with type 2 diabetes: a meta-analysis of individual participant data from randomised controlled trials. Lancet Diabetes Endocrinol. 2017;5(6):431–7.

    Article  PubMed  Google Scholar 

  7. Glycemic targets: standards of medical Care in Diabetes—2021. Diabetes Care. 2021;44(Supplement 1):S73–84.

    Google Scholar 

  8. UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998;352(9131):854–65.

    Article  Google Scholar 

  9. Zelniker TA, Braunwald E. Cardiac and renal effects of sodium-glucose co-transporter 2 inhibitors in diabetes: JACC state-of-the-art review. J Am Coll Cardiol. 2018;72(15):1845–55.

    Article  CAS  PubMed  Google Scholar 

  10. Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373(22):2117–28.

    Article  CAS  PubMed  Google Scholar 

  11. Neal B, Perkovic V, Mahaffey KW, de Zeeuw D, Fulcher G, Erondu N, et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017;377(7):644–57.

    Article  CAS  PubMed  Google Scholar 

  12. Wiviott SD, Raz I, Bonaca MP, Mosenzon O, Kato ET, Cahn A, et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2019;380(4):347–57.

    Article  CAS  PubMed  Google Scholar 

  13. Perkovic V, Jardine MJ, Neal B, Bompoint S, Heerspink HJL, Charytan DM, et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med. 2019;380(24):2295–306.

    Article  CAS  PubMed  Google Scholar 

  14. Heerspink HJL, Stefansson BV, Correa-Rotter R, Chertow GM, Greene T, Hou FF, et al. Dapagliflozin in patients with chronic kidney disease. N Engl J Med. 2020;383(15):1436–46.

    Article  CAS  PubMed  Google Scholar 

  15. Microvascular complications and foot care: standards of medical Care in Diabetes—2021. Diabetes Care. 2021;44(Supplement 1):S151–67.

    Google Scholar 

  16. Pfeffer MA, Claggett B, Diaz R, Dickstein K, Gerstein HC, Køber LV, et al. Lixisenatide in patients with type 2 diabetes and acute coronary syndrome. N Engl J Med. 2015;373(23):2247–57.

    Article  CAS  PubMed  Google Scholar 

  17. Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JFE, Nauck MA, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016;375(4):311–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Mann JFE, Ørsted DD, Brown-Frandsen K, Marso SP, Poulter NR, Rasmussen S, et al. Liraglutide and renal outcomes in type 2 diabetes. N Engl J Med. 2017;377(9):839–48.

    Article  CAS  PubMed  Google Scholar 

  19. Marso SP, Bain SC, Consoli A, Eliaschewitz FG, Jódar E, Leiter LA, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016;375(19):1834–44.

    Article  CAS  PubMed  Google Scholar 

  20. Gerstein HC, Colhoun HM, Dagenais GR, Diaz R, Lakshmanan M, Pais P, et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. Lancet. 2019;394(10193):121–30.

    Article  CAS  PubMed  Google Scholar 

  21. Pharmacologic approaches to glycemic treatment: standards of medical Care in Diabetes—2021. Diabetes Care. 2021;44(Supplement 1):S111–24.

    Google Scholar 

  22. Van Buren PN, Toto R. Hypertension in diabetic nephropathy: epidemiology, mechanisms, and management. Adv Chronic Kidney Dis. 2011;18(1):28–41.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lewis EJ, Hunsicker LG, Bain RP, Rohde RD. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. The collaborative study group. N Engl J Med. 1993;329(20):1456–62.

    Article  CAS  PubMed  Google Scholar 

  24. Lewis EJ, Hunsicker LG, Clarke WR, Berl T, Pohl MA, Lewis JB, et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med. 2001;345(12):851–60.

    Article  CAS  PubMed  Google Scholar 

  25. Keane WF, Brenner BM, de Zeeuw D, Grunfeld JP, McGill J, Mitch WE, et al. The risk of developing end-stage renal disease in patients with type 2 diabetes and nephropathy: the RENAAL study. Kidney Int. 2003;63(4):1499–507.

    Article  PubMed  Google Scholar 

  26. 10. Cardiovascular disease and risk management: standards of medical Care in Diabetes-2021. Diabetes Care. 2021;44(Suppl 1):S125–50.

    Google Scholar 

  27. Mann JF, Schmieder RE, McQueen M, Dyal L, Schumacher H, Pogue J, et al. Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial. Lancet. 2008;372(9638):547–53.

    Article  CAS  PubMed  Google Scholar 

  28. Fried LF, Emanuele N, Zhang JH, Brophy M, Conner TA, Duckworth W, et al. Combined angiotensin inhibition for the treatment of diabetic nephropathy. N Engl J Med. 2013;369(20):1892–903.

    Article  CAS  PubMed  Google Scholar 

  29. Toto RD. Management of hypertensive chronic kidney disease: role of calcium channel blockers. J Clin Hypertens (Greenwich). 2005;7(4 Suppl 1):15–20.

    Article  CAS  Google Scholar 

  30. Alexandrou ME, Papagianni A, Tsapas A, Loutradis C, Boutou A, Piperidou A, et al. Effects of mineralocorticoid receptor antagonists in proteinuric kidney disease: a systematic review and meta-analysis of randomized controlled trials. J Hypertens. 2019;37(12):2307–24.

    Article  CAS  PubMed  Google Scholar 

  31. Makino H, Haneda M, Babazono T, Moriya T, Ito S, Iwamoto Y, et al. Prevention of transition from incipient to overt nephropathy with telmisartan in patients with type 2 diabetes. Diabetes Care. 2007;30(6):1577–8.

    Article  CAS  PubMed  Google Scholar 

  32. Haller H, Ito S, Izzo JL Jr, Januszewicz A, Katayama S, Menne J, et al. Olmesartan for the delay or prevention of microalbuminuria in type 2 diabetes. N Engl J Med. 2011;364(10):907–17.

    Article  CAS  PubMed  Google Scholar 

  33. Pan A, Wang Y, Talaei M, Hu FB. Relation of smoking with Total mortality and cardiovascular events among patients with diabetes mellitus: a meta-analysis and systematic review. Circulation. 2015;132(19):1795–804.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: a systematic analysis from the global burden of disease study 2015. Lancet. 2017;389(10082):1885–906.

    Google Scholar 

  35. Sawicki PT, Mühlhauser I, Bender R, Pethke W, Heinemann L, Berger M. Effects of smoking on blood pressure and proteinuria in patients with diabetic nephropathy. J Intern Med. 1996;239(4):345–52.

    Article  CAS  PubMed  Google Scholar 

  36. Xia J, Wang L, Ma Z, Zhong L, Wang Y, Gao Y, et al. Cigarette smoking and chronic kidney disease in the general population: a systematic review and meta-analysis of prospective cohort studies. Nephrol Dial Transplant. 2017;32(3):475–87.

    Article  CAS  PubMed  Google Scholar 

  37. Sawicki PT, Didjurgeit U, Mühlhauser I, Bender R, Heinemann L, Berger M. Smoking is associated with progression of diabetic nephropathy. Diabetes Care. 1994;17(2):126–31.

    Article  CAS  PubMed  Google Scholar 

  38. Gambaro G, Bax G, Fusaro M, Normanno M, Manani SM, Zanella M, et al. Cigarette smoking is a risk factor for nephropathy and its progression in type 2 diabetes mellitus. Diabetes Nutr Metab. 2001;14(6):337–42.

    CAS  PubMed  Google Scholar 

  39. Klahr S, Buerkert J, Purkerson ML. Role of dietary factors in the progression of chronic renal disease. Kidney Int. 1983;24(5):579–87.

    Article  CAS  PubMed  Google Scholar 

  40. Mozaffarian D, Fahimi S, Singh GM, Micha R, Khatibzadeh S, Engell RE, et al. Global sodium consumption and death from cardiovascular causes. N Engl J Med. 2014;371(7):624–34.

    Article  PubMed  Google Scholar 

  41. Lambers Heerspink HJ, Holtkamp FA, Parving HH, Navis GJ, Lewis JB, Ritz E, et al. Moderation of dietary sodium potentiates the renal and cardiovascular protective effects of angiotensin receptor blockers. Kidney Int. 2012;82(3):330–7.

    Article  PubMed  CAS  Google Scholar 

  42. Cook NR, Cutler JA, Obarzanek E, Buring JE, Rexrode KM, Kumanyika SK, et al. Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP). BMJ. 2007;334(7599):885–8.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019;393(10184):1958–72.

    Google Scholar 

  44. Humalda JK, Navis G. Dietary sodium restriction: a neglected therapeutic opportunity in chronic kidney disease. Curr Opin Nephrol Hypertens. 2014;23(6):533–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. McMahon EJ, Bauer JD, Hawley CM, Isbel NM, Stowasser M, Johnson DW, et al. A randomized trial of dietary sodium restriction in CKD. J Am Soc Nephrol. 2013;24(12):2096–103.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. 5. Facilitating behavior change and Well-being to improve health outcomes: standards of medical Care in Diabetes-2021. Diabetes Care. 2021;44(Suppl 1):S53–72.

    Google Scholar 

  47. Thompson S, Wiebe N, Padwal RS, Gyenes G, Headley SAE, Radhakrishnan J, et al. The effect of exercise on blood pressure in chronic kidney disease: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2019;14(2):e0211032.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Heiwe S, Jacobson SH. Exercise training in adults with CKD: a systematic review and meta-analysis. Am J Kidney Dis. 2014;64(3):383–93.

    Article  PubMed  Google Scholar 

  49. Afsar B, Siriopol D, Aslan G, Eren OC, Dagel T, Kilic U, et al. The impact of exercise on physical function, cardiovascular outcomes and quality of life in chronic kidney disease patients: a systematic review. Int Urol Nephrol. 2018;50(5):885–904.

    Article  PubMed  Google Scholar 

  50. Vanhees L, Geladas N, Hansen D, Kouidi E, Niebauer J, Reiner Z, et al. Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular risk factors: recommendations from the EACPR. Part II. Eur J Prev Cardiol. 2012;19(5):1005–33.

    Article  CAS  PubMed  Google Scholar 

  51. 8. obesity management for the treatment of type 2 diabetes: standards of medical care in diabetes-2021. Diabetes Care. 2021;44(Suppl 1):S100–10.

    Google Scholar 

  52. Arnett DK, Khera A, Blumenthal RS. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: part 1, lifestyle and behavioral factors. JAMA Cardiol. 2019;4(10):1043–4.

    Article  PubMed  Google Scholar 

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Correspondence to Sankar D. Navaneethan .

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Aggarwal, N., Ali, S., Navaneethan, S.D. (2022). Diabetes and Kidney Disease: A Review of the Clinical Practice Guidelines. In: Lerma, E.V., Batuman, V. (eds) Diabetes and Kidney Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-86020-2_2

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  • DOI: https://doi.org/10.1007/978-3-030-86020-2_2

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