Asian Pacific Society of Nephrology Clinical Practice Guideline on Diabetic Kidney Disease – Executive Summary

Liew, Adrian; Bavanandan, Sunita; Prasad, Narayan; Chang, Jer Ming; Eiam‐Ong, Somchai; Hao, Chuan Ming; Lim, Chiao Yuen; Lim, Soo Kun; Oh, Kook Hwan; Okada, Hirokazu; Susantitaphong, Paweena; Lydia, Aida; Tran, Hoanh; Villanueva, Russell; Yeo, See Cheng; Tang, Sydney C. W.

doi:10.1111/nep.13763

Cited by 12 publications

(5 citation statements)

References 2 publications

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“…Metformin, SGLT2is, and GLP-1 RAs could have additional benefits in weight loss [17]. However, clinicians are advised to be cautious with caloric restriction, especially in patients with advanced CKD, because it can lead to malnutrition and other adverse outcomes [16].…”

Section: Lifestyle Modificationmentioning

confidence: 99%

“…Furthermore, in the Veterans Affairs Diabetes Trial, intensive diabetes control to an average HbA1c of 6.9% showed no significant benefit in microvascular complications [22]. The current KDIGO guideline recommends an individualized HbA1c target ranging from 6.5% to 8%, depending on the risk profile for developing hypoglycemia, whereas the Asian Pacific Society of Nephrology (APSN) guideline suggests that the target not be lower than 7% to balance the risks of micro-and macrovascular complications against the development of hypoglycemia [17]. The glycemic target should definitely be individualized based on the patient's severity of CKD, life expectancy, comorbidities, macrovascular complications, propensity of treatment to hypoglycemia, and awareness.…”

Section: Glycemic Controlmentioning

confidence: 99%

“…The current APSN clinical guideline for DKD recommends that blood pressure be lowered toward 130/80 mmHg to offer stroke and cardiovascular protection and slow kidney disease progression [17]. In the 2021 Joint Association of British Clinical Diabetologists and UK Kidney Association guideline, the blood pressure target varies with the stage of CKD and degree of proteinuria.…”

Section: Blood Pressure Controlmentioning

confidence: 99%

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Advances in the management of diabetic kidney disease: beyond sodium-glucose co-transporter 2 inhibitors

Chan

Tang

2022

Kidney Res Clin Pract

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Progress in the treatment of diabetic kidney disease (DKD) has been modest since the early trials on renin-angiotensin-aldosterone system inhibitors (RAASis). Although sodium-glucose co-transporter 2 inhibitors (SGLT2is) have revolutionized the management of DKD by lowering proteinuria and protecting organs, other novel treatment approaches with good evidence and efficacy that can be used in conjunction with a RAASi or SGLT2i in managing DKD have emerged in the past few years. This review discusses the evidence for glucagon-like peptide-1 receptor agonist, selective mineralocorticoid receptor antagonist, and selective endothelin A receptor antagonist, emerging treatment options for DKD beyond SGLT2 inhibition.

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Section: Lifestyle Modificationmentioning

confidence: 99%

Section: Glycemic Controlmentioning

confidence: 99%

Section: Blood Pressure Controlmentioning

confidence: 99%

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Advances in the management of diabetic kidney disease: beyond sodium-glucose co-transporter 2 inhibitors

Chan

Tang

2022

Kidney Res Clin Pract

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“…Notably, the development of progressive proteinuria is a prominent feature of DN, and effectively preventing and managing proteinuria presents a significant challenge in DN treatment [ 6 ]. The American Society of Nephrology (ASPN) Clinical Practice Guidelines recommend using the urine albumin-to-creatinine ratio as a screening tool for kidney disease in adults with diabetes mellitus [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Scutellarin ameliorates diabetic nephropathy via TGF-β1 signaling pathway

Huang,

Han,

Tan

et al. 2024

Nat. Prod. Bioprospect.

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Breviscapine, a natural flavonoid mixture derived from the traditional Chinese herb Erigeron breviscapus (Vant.) Hand-Mazz, has demonstrated a promising potential in improving diabetic nephropathy (DN). However, the specific active constituent(s) responsible for its therapeutic effects and the underlying pharmacological mechanisms remain unclear. In this study, we aimed to investigate the impact of scutellarin, a constituent of breviscapine, on streptozotocin-induced diabetic nephropathy and elucidate its pharmacological mechanism(s). Our findings demonstrate that scutellarin effectively ameliorates various features of DN in vivo, including proteinuria, glomerular expansion, mesangial matrix accumulation, renal fibrosis, and podocyte injury. Mechanistically, scutellarin appears to exert its beneficial effects through modulation of the transforming growth factor-β1 (TGF-β1) signaling pathway, as well as its interaction with the extracellular signal-regulated kinase (Erk) and Wnt/β-catenin pathways. Graphical Abstract

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“…Early intervention with hypoglycemic and antihypertensive treatment is beneficial to delay the occurrence and development of DKD ( Martins and Norris, 2001 ). Especially recommended in normal blood pressure adults with DM and albuminuria is angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) ( Liew et al, 2020 ). Blockade of the renin–angiotensin system ameliorates the expression of ANGPTL2 and integrin which maintain the glomerular barrier ( Tawfik et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Anti-Apoptosis of Podocytes and Pro-Apoptosis of Mesangial Cells for Telmisartan in Alleviating Diabetic Kidney Injury

Wei

et al. 2022

Front. Pharmacol.

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Podocytes damage and mesangial cells expansion are two important pathological manifestations of glomerular injury in early diabetes. Telmisartan, as an angiotensin type 1 (AT1) receptor inhibitor, could improve advanced glycation end (AGE) products or angiotensin Ⅱ (Ang Ⅱ)-induced podocytes injury including detachment or apoptosis. In this current paper, we first confirmed the protective effect of telmisartan on early diabetic kidney injury in type 1 diabetic rats. Telmisartan reduced the loss of podocin and inhibited the expression of α-SMA, reflecting its protective effect on podocyte injury and mesangial proliferation, respectively. More interestingly we observed an opposite effect of telmisartan on the cell viability and apoptosis of podocytes and mesangial cells in a high-glucose environment in vitro. The anti-apoptotic effect of telmisartan on podocytes might be related to its inhibition of swiprosin-1 (a protein can mediate high glucose-induced podocyte apoptosis) expression. While telmisartan induced a high expression of PPARγ in mesangial cells, and GW9662 (a PPARγ antagonist) partially inhibited telmisartan-induced apoptosis and reduced viability of mesangial cells. In addition, high glucose-induced PKCβ1/TGFβ1 expression in mesangial cells could be blocked by telmisartan. These data provide a more precise cellular mechanism for revealing the protective effect of telmisartan in diabetic kidney injury.

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Asian Pacific Society of Nephrology Clinical Practice Guideline on Diabetic Kidney Disease – Executive Summary

Cited by 12 publications

References 2 publications

Advances in the management of diabetic kidney disease: beyond sodium-glucose co-transporter 2 inhibitors

Advances in the management of diabetic kidney disease: beyond sodium-glucose co-transporter 2 inhibitors

Scutellarin ameliorates diabetic nephropathy via TGF-β1 signaling pathway

Anti-Apoptosis of Podocytes and Pro-Apoptosis of Mesangial Cells for Telmisartan in Alleviating Diabetic Kidney Injury

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