How to Assess Diabetic Kidney Disease Progression? From Albuminuria to GFR

Abstract

Diabetic kidney disease (DKD) is one of the most relevant complications of type 2 diabetes and dramatically increases the cardiovascular risk in these patients. Currently, DKD is severely infra-diagnosed, or its diagnosis is usually made at advanced stages of the disease. During the last decade, new drugs have demonstrated a beneficial effect in terms of cardiovascular and renal protection in type 2 diabetes, supporting the crucial role of an early DKD diagnosis to permit the use of new available therapeutic strategies. Moreover, cardiovascular and renal outcome trials, developed to study these new drugs, are based on diverse cardiovascular and renal simple and composite endpoints, which makes difficult their interpretation and the comparison between them. In this article, DKD diagnosis is reviewed, focusing on albuminuria and the recommendations for glomerular filtration rate measurement. Furthermore, cardiovascular and renal endpoints used in classical and recent cardiovascular outcome trials are assessed in a pragmatic way.

Association of serum uric acid with albuminuria in type 2 diabetic patients with comorbid obesity and/or essential arterial hypertension

“…Even more, questions arise about the association between hyperuricemia and CKD in the comorbid course of diabetes, in particular in obese patients with dyslipidemia and AH. Albuminuria has been classically considered the first diabetic kidney disease clinical indicator, a biomarker for its progression, and a cause of impairment of GFR [40]. In the present study, we found normoalbuminuria in type 2 diabetic patients of all studied groups.…”

Pharmacotherapy to delay the progression of diabetic kidney disease in people with type 2 diabetes: past, present and future

“…63 Although various studies have looked at renal outcomes, due to the heterogeneity in the endpoints it is important to unify major adverse renal events (MARE) which has been proposed and this can be used to design future clinical trial focussed on DKD. 64,65 However, there remains a difficulty in building an evidence base for judicious use of certain classes of drugs in groups of patients at a low risk of adverse events, for whom a matched placebo group may not reach pre-specified end-points at a sufficient rate.…”

Update on diabetic kidney disease

“…El diagnóstico de la ERD se fundamenta en los hallazgos clínicos (20). En primera instancia se debe establecer la presencia de diabetes mellitus, y segundo, demostrar la presencia de enfermedad renal definida por la presencia de albuminuria y/o disminución en tasa de filtrado glomerular (TFG) (21).…”

“…En pacientes con DM, la caída de TFG por debajo de 60 mL/min/1.73 m2 y/o la existencia de albuminuria (Cociente albúmina/creatinina en orina > 30 mg/g) en dos determinaciones con al menos 3 meses de diferencia es suficiente para establecer el diagnóstico de nefropatía diabética (20). Este concepto tiene una baja especificidad y una amplia variedad de lesiones histológicas, podrían explicar estos cambios, sin estar relacionadas con la DM.…”