Clinical therapeutic strategies for early stage of diabetic kidney disease

Abstract

Diabetic kidney disease (DKD) is the most common cause of chronic kidney disease, leading to end-stage renal disease and cardiovascular disease. The overall number of patients with DKD will continue to increase in parallel with the increasing global pandemic of type 2 diabetes. Based on landmark clinical trials, DKD has become preventable by controlling conventional factors, including hyperglycemia and hypertension, with multifactorial therapy; however, the remaining risk of DKD progression is still high. In this review, we show the importance of targeting remission/regression of microalbuminuria in type 2 diabetic patients, which may protect against the progression of DKD and cardiovascular events. To achieve remission/regression of microalbuminuria, several steps are important, including the early detection of microalbuminuria with continuous screening, targeting HbA1c < 7.0% for glucose control, the use of renin angiotensin system inhibitors to control blood pressure, the use of statins or fibrates to control dyslipidemia, and multifactorial treatment. Reducing microalbuminuria is therefore an important therapeutic goal, and the absence of microalbuminuria could be a pivotal biomarker of therapeutic success in diabetic patients. Other therapies, including vitamin D receptor activation, uric acid-lowering drugs, and incretin-related drugs, may also be promising for the prevention of DKD progression.

Keywords: Diabetic kidney disease; Glycemic control; Multifactorial therapy; Remission and regression of albuminuria; Renin-angiotensin system inhibitor.

Figure 1

Therapeutic strategy for diabetic kidney disease. Multifactorial therapy, consisting of glycemic, blood pressure, and lipid control, is recommended to prevent the progression of diabetic kidney disease (DKD). The remission and regression of albuminuria by multifactorial therapy may be closely associated with reduced risk of progression of both DKD and cardiovascular disease. In addition to these therapies, vitamin D receptor activation, uric acid-lowering drugs, and incretin-related drugs should be considered in the prospective treatment of DKD.

Figure 2

Beneficial effects of renin-angiotensin system inhibitors. Numerous landmark studies have shown the effectiveness of renin-angiotensin system inhibitors on diabetic kidney disease.