Diabetic kidney disease: a clinical update from Kidney Disease: Improving Global Outcomes
Open accessAbstract
The incidence and prevalence of diabetes mellitus (DM) continue to grow dramatically throughout the world, due primarily to the increase in type 2 DM (T2DM). Although improvements in DM and hypertension management have reduced the proportion of diabetic individuals who develop chronic kidney disease (CKD) and progress to end-stage renal disease (ESRD), the sheer increase in people developing DM will have a major impact on dialysis and transplant needs. This KDIGO conference addressed a number of controversial areas in the management of DM patients with CKD, including aspects of screening for CKD with measurements of albuminuria and estimated glomerular filtration rate (eGFR); defining treatment outcomes; glycemic management in both those developing CKD and those with ESRD; hypertension goals and management, including blockers of the renin-angiotensin-aldosterone system; and lipid management.
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The absence of effect modification by baseline albuminuria contrasts with findings from trials of RAS blockade.
“The absence of effect modification by baseline albuminuria contrasts with the findings from trials of RAS blockade.[31][32][33]”
From SGLT2 inhibitors for the prevention of kidney failure in patients with type 2 diabetes: a systematic review and meta-analysis (2019) · cites this paper as [33]
The Abstract says the benefit of RAAS blockade for CKD progression in people without increased albumin excretion is unclear, while BP management reports benefits in several trials involving hypertensive diabetic patients. This supports a contrast in the evidence across patient groups, but the paper does not report that baseline albuminuria itself modified the treatment effect; the groups also differ in blood pressure status. Page numbers are not available in our copy. (LLM, conf=0.78)
Experimental — accuracy not yet measuredIndividuals with chronic kidney disease may be at increased risk of hypoglycemia and HbA1c can be falsely low.
“Diabetes management may be particularly challenging in individuals with chronic kidney disease who may be at an increased risk of hypoglycemia and in whom HbA 1c can be falsely low (276)”
From The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (2021) · cites this paper as [276]
The Glycemic control to minimize DKD section states that severe hypoglycemia risk increases as CKD advances. It suggests that glycated albumin may reflect glycemic control more accurately in this population, but the passages do not say that HbA1c can be falsely low. (LLM, conf=0.85)
Experimental — accuracy not yet measured
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- Authors
- Molitch, M. E., Adler, A. I., Flyvbjerg, A., Nelson, R. G., So, W.-Y., Wanner, C., Kasiske, B. L., Wheeler, D. C., de Zeeuw, D., & Mogensen, C. E.
- Affiliations
- Northwestern University (US)
- Addenbrooke's Hospital (GB)
- Aarhus University (DK)
- National Institute of Diabetes and Digestive and Kidney Diseases (US)
- Chinese University of Hong Kong (HK)
- Universitätsklinikum Würzburg (DE)
- Hennepin County Medical Center (US)
- University College London (GB)
- Aarhus University Hospital (DK)
- Corresponding author
- Molitch, Mark E.
- ORCID
- Venue
- Kidney International
- Publisher
- Elsevier BV
- Published
- 2015-01
- Volume
- 87
- Issue
- 1
- Pages
- 20-30
- ISSN
- 0085-2538 (ISSN-L)
- PMC
- PMC4214898
- OpenAlex
- W2136160292
- Semantic Scholar
- f2af4f6271bd70cd0bbaacb694a7a365a61dea86
- Cited by
- 268
- References
- 135
- Citations by year
- 2026: 18 · 2025: 17 · 2024: 20 · 2023: 17 · 2022: 24 · 2021: 31 · 2020: 34 · 2019: 22 · 2018: 26 · 2017: 23 · 2016: 15 · 2015: 15 · 2014: 5
- FWCI
- 15.29
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Kidney International (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
- PubMed Central (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- diabetic nephropathy, chronic kidney disease, type 2 diabetes, end-stage renal disease, albuminuria, estimated glomerular filtration rate, CKD screening, glycemic control, antihypertensive therapy, renin-angiotensin-aldosterone system inhibitors, lipid control, treatment outcomes
- MeSH terms
- Albuminuria, Diabetic Nephropathies, Humans, Hyperglycemia, Hypertension, Disease Progression
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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