Management of Type 2 Diabetic Kidney Disease in 2022: A Narrative Review for Specialists and Primary Care
Purpose of review: Kidney disease is present in almost half of Canadian patients with type 2 diabetes (T2D), and it is also the most common first cardiorenal manifestation of T2D. Despite clear guidelines for testing, opportunities are being missed to identify kidney diseases, and many Canadians are...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2023-01-01
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| Series: | Canadian Journal of Kidney Health and Disease |
| Online Access: | https://doi.org/10.1177/20543581221150556 |
| _version_ | 1797942633393291264 |
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| author | David Z. I. Cherney Alan Bell Louis Girard Philip McFarlane Louise Moist Sharon J. Nessim Steven Soroka Sara Stafford Andrew Steele Navdeep Tangri Jordan Weinstein |
| author_facet | David Z. I. Cherney Alan Bell Louis Girard Philip McFarlane Louise Moist Sharon J. Nessim Steven Soroka Sara Stafford Andrew Steele Navdeep Tangri Jordan Weinstein |
| author_sort | David Z. I. Cherney |
| collection | DOAJ |
| description | Purpose of review: Kidney disease is present in almost half of Canadian patients with type 2 diabetes (T2D), and it is also the most common first cardiorenal manifestation of T2D. Despite clear guidelines for testing, opportunities are being missed to identify kidney diseases, and many Canadians are therefore not receiving the best available treatments. This has become even more important given recent clinical trials demonstrating improvements in both kidney and cardiovascular (CV) endpoints with sodium-glucose cotransporter 2 (SGLT2) inhibitors and a nonsteroidal mineralocorticoid receptor antagonist, finerenone. The goal of this document is to provide a narrative review of the current evidence for the treatment of diabetic kidney disease (DKD) that supports this new standard of care and to provide practice points. Sources of information: An expert panel of Canadian clinicians was assembled, including 9 nephrologists, an endocrinologist, and a primary care practitioner. The information the authors used for this review consisted of published clinical trials and guidelines, selected by the authors based on their assessment of their relevance to the questions being answered. Methods: Panelists met virtually to discuss potential questions to be answered in the review and agreed on 10 key questions. Two panel members volunteered as co-leads to write the summaries and practice points for each of the identified questions. Summaries and practice points were distributed to the entire author list by email. Through 2 rounds of online voting, a second virtual meeting, and subsequent email correspondence, the authors reached consensus on the contents of the review, including all the practice points. Key findings: It is critical that DKD be identified as early as possible in the course of the disease to optimally prevent disease progression and associated complications. Patients with diabetes should be routinely screened for DKD with assessments of both urinary albumin and kidney function. Treatment decisions should be individualized based on the risks and benefits, patients’ needs and preferences, medication access and cost, and the degree of glucose lowering needed. Patients with DKD should be treated to achieve targets for A1C and blood pressure. Renin-angiotensin-aldosterone system blockade and treatment with SGLT2 inhibitors are also key components of the standard of care to reduce the risk of kidney and CV events for these patients. Finerenone should also be considered to further reduce the risk of CV events and chronic kidney disease progression. Education of patients with diabetes prescribed SGLT2 inhibitors and/or finerenone is an important component of treatment. Limitations: No formal guideline process was used. The practice points are not graded and are not intended to be viewed as having the weight of a clinical practice guideline or formal consensus statement. However, most practice points are well aligned with current clinical practice guidelines. |
| first_indexed | 2024-04-10T20:11:40Z |
| format | Article |
| id | doaj.art-c618e8584c56469285c5ff396de1b8e7 |
| institution | Directory Open Access Journal |
| issn | 2054-3581 |
| language | English |
| last_indexed | 2024-04-10T20:11:40Z |
| publishDate | 2023-01-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Canadian Journal of Kidney Health and Disease |
| spelling | doaj.art-c618e8584c56469285c5ff396de1b8e72023-01-26T11:10:45ZengSAGE PublishingCanadian Journal of Kidney Health and Disease2054-35812023-01-011010.1177/20543581221150556Management of Type 2 Diabetic Kidney Disease in 2022: A Narrative Review for Specialists and Primary CareDavid Z. I. Cherney0Alan Bell1Louis Girard2Philip McFarlane3Louise Moist4Sharon J. Nessim5Steven Soroka6Sara Stafford7Andrew Steele8Navdeep Tangri9Jordan Weinstein10Temerty Faculty of Medicine, University of Toronto, ON, CanadaDepartment of Family & Community Medicine, University of Toronto, ON, CanadaDivision of Nephrology, Department of Medicine, Cumming School of Medicine, University of Calgary, AB, CanadaDivision of Nephrology, Department of Medicine, Toronto General Hospital, University of Toronto, ON, CanadaDivision of Nephrology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, CanadaDivision of Nephrology, Jewish General Hospital, McGill University, Montreal, QC, CanadaQEII Health Sciences Centre, Nova Scotia Health, Halifax, CanadaFraser Health Division of Endocrinology, University of British Columbia, Surrey, CanadaLakeridge Health, Whitby, ON, CanadaDepartments of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, CanadaDivision of Nephrology, St. Michael’s Hospital, University of Toronto, ON, CanadaPurpose of review: Kidney disease is present in almost half of Canadian patients with type 2 diabetes (T2D), and it is also the most common first cardiorenal manifestation of T2D. Despite clear guidelines for testing, opportunities are being missed to identify kidney diseases, and many Canadians are therefore not receiving the best available treatments. This has become even more important given recent clinical trials demonstrating improvements in both kidney and cardiovascular (CV) endpoints with sodium-glucose cotransporter 2 (SGLT2) inhibitors and a nonsteroidal mineralocorticoid receptor antagonist, finerenone. The goal of this document is to provide a narrative review of the current evidence for the treatment of diabetic kidney disease (DKD) that supports this new standard of care and to provide practice points. Sources of information: An expert panel of Canadian clinicians was assembled, including 9 nephrologists, an endocrinologist, and a primary care practitioner. The information the authors used for this review consisted of published clinical trials and guidelines, selected by the authors based on their assessment of their relevance to the questions being answered. Methods: Panelists met virtually to discuss potential questions to be answered in the review and agreed on 10 key questions. Two panel members volunteered as co-leads to write the summaries and practice points for each of the identified questions. Summaries and practice points were distributed to the entire author list by email. Through 2 rounds of online voting, a second virtual meeting, and subsequent email correspondence, the authors reached consensus on the contents of the review, including all the practice points. Key findings: It is critical that DKD be identified as early as possible in the course of the disease to optimally prevent disease progression and associated complications. Patients with diabetes should be routinely screened for DKD with assessments of both urinary albumin and kidney function. Treatment decisions should be individualized based on the risks and benefits, patients’ needs and preferences, medication access and cost, and the degree of glucose lowering needed. Patients with DKD should be treated to achieve targets for A1C and blood pressure. Renin-angiotensin-aldosterone system blockade and treatment with SGLT2 inhibitors are also key components of the standard of care to reduce the risk of kidney and CV events for these patients. Finerenone should also be considered to further reduce the risk of CV events and chronic kidney disease progression. Education of patients with diabetes prescribed SGLT2 inhibitors and/or finerenone is an important component of treatment. Limitations: No formal guideline process was used. The practice points are not graded and are not intended to be viewed as having the weight of a clinical practice guideline or formal consensus statement. However, most practice points are well aligned with current clinical practice guidelines.https://doi.org/10.1177/20543581221150556 |
| spellingShingle | David Z. I. Cherney Alan Bell Louis Girard Philip McFarlane Louise Moist Sharon J. Nessim Steven Soroka Sara Stafford Andrew Steele Navdeep Tangri Jordan Weinstein Management of Type 2 Diabetic Kidney Disease in 2022: A Narrative Review for Specialists and Primary Care Canadian Journal of Kidney Health and Disease |
| title | Management of Type 2 Diabetic Kidney Disease in 2022: A Narrative Review for Specialists and Primary Care |
| title_full | Management of Type 2 Diabetic Kidney Disease in 2022: A Narrative Review for Specialists and Primary Care |
| title_fullStr | Management of Type 2 Diabetic Kidney Disease in 2022: A Narrative Review for Specialists and Primary Care |
| title_full_unstemmed | Management of Type 2 Diabetic Kidney Disease in 2022: A Narrative Review for Specialists and Primary Care |
| title_short | Management of Type 2 Diabetic Kidney Disease in 2022: A Narrative Review for Specialists and Primary Care |
| title_sort | management of type 2 diabetic kidney disease in 2022 a narrative review for specialists and primary care |
| url | https://doi.org/10.1177/20543581221150556 |
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