Diabetic kidney disease: New clinical and therapeutic issues. Joint position statement of the Italian Diabetes Society and the Italian Society of Nephrology on "The natural history of diabetic kidney disease and treatment of hyperglycemia in patients with type 2 diabetes and impaired renal function".

Abstract

AIMS:

This joint document of the Italian Diabetes Society and the Italian Society of Nephrology reviews the natural history of diabetic kidney disease (DKD) in the light of the recent epidemiological literature and provides updated recommendations on anti-hyperglycemic treatment with non-insulin agents.

DATA SYNTHESIS:

Recent epidemiological studies have disclosed a wide heterogeneity of DKD. In addition to the classical albuminuric phenotype, two new albuminuria-independent phenotypes have emerged, i.e., "nonalbuminuric renal impairment" and "progressive renal decline", suggesting that DKD progression toward end-stage kidney disease (ESKD) may occur through two distinct pathways, albuminuric and nonalbuminuric. Several biomarkers have been associated with decline of estimated glomerular filtration rate (eGFR) independent of albuminuria and other clinical variables, thus possibly improving ESKD prediction. However, the pathogenesis and anatomical correlates of these phenotypes are still unclear. Also the management of hyperglycemia in patients with type 2 diabetes and impaired renal function has profoundly changed during the last two decades. New anti-hyperglycemic drugs, which do not cause hypoglycemia and weight gain and, in some cases, seem to provide cardiorenal protection, have become available for treatment of these individuals. In addition, the lowest eGFR safety thresholds for some of the old agents, particularly metformin and insulin secretagogues, have been reconsidered.

CONCLUSIONS:

The heterogeneity in the clinical presentation and course of DKD has important implications for the diagnosis, prognosis, and possibly treatment of this complication. The therapeutic options for patients with type 2 diabetes and impaired renal function have substantially increased, thus allowing a better management of these individuals.

• Authors: Giuseppe Pugliese, Giuseppe Penno, Andrea Natali, Federica Barutta, Salvatore Di Paolo, Gianpaolo Reboldi, Loreto Gesualdo, Luca De Nicola, Italian Diabetes Society and the Italian Society of Nephrology
• Journal: Nutrition, metabolism, and cardiovascular diseases : NMCD (Nutr Metab Cardiovasc Dis) Vol. 29 Issue 11 Pg. 1127-1150 (11 2019) ISSN: 1590-3729 [Electronic] Netherlands
• PMID: 31586514 (Publication Type: Journal Article, Practice Guideline, Review)
• Copyright: Copyright © 2019 Giuseppe Pugliese, Giuseppe Penno, Andrea Natali, Federica Barutta, Salvatore Di Paolo, Gianpaolo Reboldi, Loreto Gesualdo, Luca De Nicola, Italian Diabetes Society and Italian Society of Nephrology. Published by Elsevier B.V. All rights reserved.

Chemical References

• Biomarkers
• Blood Glucose
• Hypoglycemic Agents

Topics

• Biomarkers (blood)
• Blood Glucose (drug effects, metabolism)
• Clinical Decision-Making
• Consensus
• Diabetes Mellitus, Type 2 (blood, diagnosis, drug therapy, epidemiology)
• Diabetic Nephropathies (diagnosis, epidemiology, physiopathology, therapy)
• Disease Progression
• Glomerular Filtration Rate
• Humans
• Hypoglycemic Agents (adverse effects, therapeutic use)
• Kidney (physiopathology)
• Kidney Failure, Chronic (diagnosis, epidemiology, physiopathology, therapy)
• Patient Selection
• Risk Factors
• Treatment Outcome