Chronic kidney disease in the context of diabetes mellitus

Czech version

Authors: Anna Török Zapletalová ^1,2; Mariana Rončáková ^1,2; Emil Martinka ¹; Peter Galajda ²
Authors‘ workplace: Diabetologické oddelenie NEDÚ n. o., Ľubochňa ¹; Jesseniova LF UK a UNM, Martin ²
Published in: Forum Diab 2024; 13(2): 59-61
Category: Review Article

Overview

Chronic kidney disease develops in almost 20–40 % of patients with diabetes. Diabetes mellitus is the leading cause of chronic kidney disease in dialysis patients. The diabetologist has a key role in diagnosis, influencing its progression and the transition to the stage of kidney failure. A patient with confirmed diabetic kidney disease has a very high cardiovascular and sudden death risk. The management of the treatment of a diabetic patient with developed renal complications should therefore be comprehensive in order to influence individual cardiovascular risk factors. A holistic approach is also preferred by the consensus of the ADA (American Diabetes Association) and KDIGO (Kidney Disease: Improving Global Outcomes) from 2022. Adjustment of lifestyle interventions, treatment of arterial hypertension, dyslipidemia and adjustment of glycemic compensation form the basic pillars of management and are the competence of the diabetologist. SGLT2-inhibitors (SGLT2i), GLP1-receptor agonists (GLP1-RA) and metformin are the preferred groups in the treatment of type 2 diabetes mellitus. Dipeptidyl peptidase 4 inhibitors, sulfonylurea derivatives and insulin therapy are considered as complementary drugs. In the case of type 1 diabetes mellitus, insulin therapy remains the only possible option. New groups of antidiabetics (SGLT2i, GLP1-RA) have a proven nephroprotective benefit (slowing down the progression of kidney disease, reducing microalbuminuria). Early initiation of nephroprotective treatment can significantly affect the patient’s risk and mortality. Complementary creating of the treatment by a diabetologist and a nephrologist is key in patient management. This article presents the possibilities of diabetic kidney disease management by a diabetologist, emphasizes the need for a comprehensive approach and close cooperation with other specialists.

Keywords:

diabetes mellitus – cardiovascular risk factors – diabetic kidney disease (DKD) – GLP1-receptor agonists (GLP1-RA) – holistic approach – SGLT2-inhibitors (SGLT2i)

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Article was published in

Forum Diabetologicum

2024 Issue 2