Diabetic kidney disease: a report from an ADA Consensus Conference
Open accessAbstract
The incidence and prevalence of diabetes mellitus have grown significantly throughout the world, due primarily to the increase in type 2 diabetes. This overall increase in the number of people with diabetes has had a major impact on development of diabetic kidney disease (DKD), one of the most frequent complications of both types of diabetes. DKD is the leading cause of end-stage renal disease (ESRD), accounting for approximately 50% of cases in the developed world. Although incidence rates for ESRD attributable to DKD have recently stabilized, these rates continue to rise in high-risk groups such as middle-aged African Americans, Native Americans, and Hispanics. The costs of care for people with DKD are extraordinarily high. In the Medicare population alone, DKD-related expenditures among this mostly older group were nearly $25 billion in 2011. Due to the high human and societal costs, the Consensus Conference on Chronic Kidney Disease and Diabetes was convened by the American Diabetes Association in collaboration with the American Society of Nephrology and the National Kidney Foundation to appraise issues regarding patient management, highlighting current practices and new directions. Major topic areas in DKD included 1) identification and monitoring, 2) cardiovascular disease and management of dyslipidemia, 3) hypertension and use of renin-angiotensin-aldosterone system blockade and mineralocorticoid receptor blockade, 4) glycemia measurement, hypoglycemia, and drug therapies, 5) nutrition and general care in advanced-stage chronic kidney disease, 6) children and adolescents, and 7) multidisciplinary approaches and medical home models for health care delivery. This current state summary and research recommendations are designed to guide advances in care and the generation of new knowledge that will meaningfully improve life for people with DKD.
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A1C levels are less reliable at advanced CKD stages.
“A1C levels are also less reliable at advanced CKD stages (64,65).”
From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [64]
A1C levels are less reliable at advanced CKD stages.
“A1C levels are also less reliable at advanced CKD stages (63,64).”
From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [63]
There is no evidence that adjusting the daily level of protein intake (typically 1-1.5 g/kg body wt/day or 15-20% total calories) will improve health, and research is inconclusive regarding the ideal amount of dietary protein to optimize either glycemic management or CVD risk.
“There is no evidence that adjusting the daily level of protein intake (typically 1-1.5 g/kg body wt/day or 15-20% total calories) will improve health, and research is inconclusive regarding the ideal amount of dietary protein to optimize either glycemic management or CVD risk (159,195).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [195]
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- Authors
- Tuttle, K. R., Bakris, G. L., Bilous, R. W., Chiang, J. L., de Boer, I. H., Goldstein-Fuchs, J., Hirsch, I. B., Kalantar-Zadeh, K., Narva, A. S., Navaneethan, S. D., Neumiller, J. J., Patel, U. D., Ratner, R. E., Whaley-Connell, A. T., & Molitch, M. E.
- Affiliations
- University of Washington (US)
- National Kidney Foundation (US)
- Newcastle University (GB)
- American Diabetes Association (US)
- Division of Nephrology, University of Washington, Seattle, WA
- Sierra Nevada Nephrology Consultants, Reno, NV
- School of Medicine, University of California, Irvine, Irvine, CA
- National Institutes of Health (US)
- Cleveland Clinic (US)
- Washington State University Spokane (US)
- Duke University (US)
- Harry S. Truman Memorial Veterans Hospital, Columbia, MO, and Department of Internal Medicine, Division of Nephrology and Hypertension, University of Missouri School of Medicine, Columbia, MO
- Northwestern University (US)
- Corresponding author
- Chiang, Jane L.
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2014-09-10
- Volume
- 37
- Issue
- 10
- Pages
- 2864-2883
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC4170131
- OpenAlex
- W2072070798
- Semantic Scholar
- 0c6864a569d8918ea51eda33aae122cff819ac65
- Cited by
- 1,153
- References
- 193
- Citations by year
- 2026: 90 · 2025: 104 · 2024: 107 · 2023: 131 · 2022: 128 · 2021: 118 · 2020: 130 · 2019: 87 · 2018: 87 · 2017: 72 · 2016: 65 · 2015: 27 · 2014: 6 · 2013: 1
- FWCI
- 44.80
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Amgen
- Bristol-Myers Squibb
- Eli Lilly and Company
- AstraZeneca
- Sanofi
- Gilead Sciences
- Halozyme
- Luitpold Pharmaceuticals
- Angion
- Novo Nordisk
- CSL Limited
- National Institutes of Health (UL1TR000430)
- Relypsa
- National Institute of Diabetes and Digestive and Kidney Diseases
- National Center for Advancing Translational Sciences
- Daiichi Sankyo Europe
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Keywords
- diabetic nephropathy, end-stage renal disease, type 2 diabetes, chronic kidney disease, cardiovascular disease, dyslipidemia, hypertension, renin-angiotensin-aldosterone system blockade, mineralocorticoid receptor antagonists, glycemic control, hypoglycemia, pharmacotherapy, pediatric diabetes, multidisciplinary care, patient-centered medical home, health care delivery
- MeSH terms
- Adolescent, Aged, Antihypertensive Agents, Blood Glucose, Cardiovascular Diseases, Child, Diabetes Mellitus, Type 2, Diabetic Nephropathies, Humans, Kidney Function Tests, Middle Aged, Incidence, Prevalence, Renal Insufficiency, Chronic
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