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Review
. 2021 Jun 5;10(11):2505.
doi: 10.3390/jcm10112505.

How to Assess Diabetic Kidney Disease Progression? From Albuminuria to GFR

Clara García-Carro  1 , Ander Vergara  2 , Sheila Bermejo  2 , María A Azancot  2 , Ana I Sánchez-Fructuoso  1 , M Dolores Sánchez de la Nieta  1 , Irene Agraz  2 , María José Soler  2
Affiliations
Review

How to Assess Diabetic Kidney Disease Progression? From Albuminuria to GFR

Clara García-Carro et al. J Clin Med. .

Abstract

Diabetic kidney disease (DKD) is one of the most relevant complications of type 2 diabetes and dramatically increases the cardiovascular risk in these patients. Currently, DKD is severely infra-diagnosed, or its diagnosis is usually made at advanced stages of the disease. During the last decade, new drugs have demonstrated a beneficial effect in terms of cardiovascular and renal protection in type 2 diabetes, supporting the crucial role of an early DKD diagnosis to permit the use of new available therapeutic strategies. Moreover, cardiovascular and renal outcome trials, developed to study these new drugs, are based on diverse cardiovascular and renal simple and composite endpoints, which makes difficult their interpretation and the comparison between them. In this article, DKD diagnosis is reviewed, focusing on albuminuria and the recommendations for glomerular filtration rate measurement. Furthermore, cardiovascular and renal endpoints used in classical and recent cardiovascular outcome trials are assessed in a pragmatic way.

Keywords: chronic kidney disease; diabetes mellitus; diabetic kidney disease.

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Conflict of interest statement

Clara García-Carro reports honorarium for conferences and advisory boards from Astra Zeneca, Mundipharma, Novonordisk, and Boehringer Ingelheim and travel support from Astellas, Menarini, Novartis, Estev, Sanofi, and Novonordisk. María José Soler reports personal fees from NovoNordisk, personal fees from Jansen, grants and personal fees from Boehringer, personal fees from Mundipharma, personal fees from AstraZeneca, personal fees from Esteve, personal fees from Fresenius, personal fees from Ingelheim Lilly, personal fees from Vifor during the conduct of the study.

Figures

Figure 1
Figure 1
Glomerular filtration rate and albuminuria over time in three different hypothetical situations of DKD. GFR decline and albuminuria can vary in patients with DKD depending on previous comorbidities and the timing of harmful events. (A) Classical phenotype of DKD with an initial hyperfiltration phase and later development of progressive albuminuria. As the disease advanced to overt nephropathy, GFR decline was observed. (B) Non-proteinuric DKD in a patient that had hypertension before a diabetes diagnosis. Note that mild albuminuria appeared only when the patient had advanced CKD. (C) Glomerular hyperfiltration in an obese patient that later developed diabetes. As hyperfiltration progressed, the patient developed massive albuminuria followed by a rapid decline in GFR. UACR: urinary albumin-to-creatinine ratio. GFR: glomerular filtration rate.
Figure 2
Figure 2
Correlation between renal function deterioration and degree of diabetic nephropathy. UAER: * Urinary albumin excretion rate: mg/gr creatinine; ** GFR mL/min/1.73 m2.
See this image and copyright information in PMC

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