Diabetes and the kidney

Abstract

Diabetes is the most common cause of end-stage kidney disease. Randomised controlled trials have shown a significant benefit of sodium-glucose transporter-2 inhibitors in patients with diabetic kidney disease (DKD), and guidelines now suggest these drugs should be considered in all patients with DKD irrespective of glucose control. Glucagon-like peptide-1 receptor agonists have shown some benefit in reducing progression of albuminuria in DKD and should also be considered early in the therapeutic pathway. Management of diabetes in patients on renal replacement therapy (dialysis or transplantation) is uniquely challenging. This article outlines guidance on management of glucose in these vulnerable groups of patients.

Keywords: diabetes; dialysis; nephropathy; sodium-glucose transporter-2; transplantation.

Fig 1.

Pathway for diagnosis and management of post-transplant diabetes mellitus. 2-hour PG = 2-hour plasma glucose; CBG = capillary blood glucose; CNI = calcineurin inhibitor; DPP-4i = dipeptidylpeptidase-4 inhibitor; eGFR = estimated glomerular filtration rate; FPG = fasting plasma glucose; GDM = gestational diabetes mellitus; HbA_1c = glycated haemoglobin; IV = intravenous; NPH = neutral protamine Hagedorn; PTDM = post-transplant diabetes mellitus; OGTT = oral glucose tolerance test; SC = subcutaneous; SGLT-2 = sodium-glucose transporter-2; VRIII = variable rate intravenous infusion of insulin.