Why the study?
This review was conducted to examine the current literature on diabetes-related kidney disease and optimal cardio-renal risk management following recent outcome trials and updated international guidelines.
SGLT2 inhibitors and renin-angiotensin system blockade are key therapies for reducing the progression of kidney disease and cardiovascular risk in patients with type 2 diabetes.
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Supports RAS blockade for DKD progression; leaves open optimal integration with newer cardio-renal therapies.
This review examines the current literature relating to diabetes related kidney disease (DKD) and the optimal management of cardio-renal risk. DKD develops in approximately 40% of patients with type 2 diabetes mellitus. The mainstay of therapy is to reduce the progression of DKD by optimising hyperglycaemia, blood pressure, lipids and lifestyle. Evidence supports the role for renin-angiotensin system blockade in limiting the progression of DKD. Recent data from diabetes related cardiovascular outcome trials and renal specific trials have provided a novel insight on the additional benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in reducing the progression of DKD as well as cardiovascular risk. Lessons have been learnt from CREDENCE and there are expectations that DAPA-CKD and EMPA-KIDNEY will further support the benefits of SGLT2 inhibition in relation to DKD. As a consequence, international guidelines have been updated to reflect the positive benefits. In addition, novel steroidal mineralocorticoid receptor antagonists offer a potential role in future years. The review examines the current evidence and future approach to optimising outcomes for renal protection in patients with diabetes.
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Stephens et al. (2020) studied this question.
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