Glomerular filtration rate as a kidney outcome of diabetic kidney disease: a focus on new antidiabetic drugs

Abstract

Diabetes has reached epidemic proportions, both in Korea and worldwide and is associated with an increased risk of chronic kidney disease and kidney failure (KF). The natural course of kidney function among people with diabetes (especially type 2 diabetes) may be complex in real-world situations. Strong evidence from observational data and clinical trials has demonstrated a consistent association between decreased estimated glomerular filtration rate (eGFR) and subsequent development of hard renal endpoints (such as KF or renal death). The disadvantage of hard renal endpoints is that they require a long follow-up duration. In addition, there are many patients with diabetes whose renal function declines without the appearance of albuminuria, measurement of the eGFR is emphasized. Many studies have used GFR-related parameters, such as its change, decline, or slope, as clinical endpoints for kidney disease progression. In this respect, understanding the trends in GFR changes could be crucial for developing clinical management strategies for the prevention of diabetic complications. This review focuses on the clinical implication of the eGFR-related parameters that have been used so far in diabetic kidney disease. We also discuss the use of recently developed new antidiabetic drugs for kidney protection, with a focus on the GFR as clinical endpoints.

Keywords: Diabetic nephropathies; Glomerular filtration rate; Hypoglycemic agents; Treatment outcome.

Figure 1

Glomerular filtration rate (GFR) as an endpoint for diabetic kidney disease outcomes in clinical trials. UACR, urinary albumin-to-creatinine ratio; eGFR, estimated glomerular filtration rate; ESKD, end-stage kidney disease; CV, cardiovascular. ^aNew onset, progression, or regression of albuminuria, ^b[34], ^c[32], ^ddefined as an eGFR of < 15 mL/min/1.73 m².