Endocrinology and Obesity Medicine | Asst Professor of Endocrinology | Director of Medical Weight Management Program @uamshealth ; Views my own.
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ALT Chronic kidney disease (CKD) screening and diagnosis for people living with diabetes. Screening includes measurement of both urine albumin and estimated glomerular filtration rate (eGFR). Abnormalities should be confirmed. Persistent abnormalities in either urine albumin-to-creatinine ratio (ACR) or eGFR (or both) diagnose CKD and should lead to immediate initiation of evidence-based treatments. T1D, type 1 diabetes; T2D, type 2 diabetes.
![Risk of chronic kidney disease (CKD) progression, frequency of visits, and referral to nephrology according to glomerular filtration rate (GFR) and albuminuria. The numbers in the boxes are a guide to the frequency of screening or monitoring (number of times per year). Green reflects no evidence of CKD by eGFR or albuminuria, with screening indicated once per year. For monitoring of prevalent CKD, suggested monitoring varies from once per year (yellow) to 4 times or more per year (i.e., every 1–3 months, [deep red]) according to risks of CKD progression and CKD complications. These are general parameters only, based on expert opinion, and underlying comorbid conditions and disease state must be taken into account, as well as the likelihood of impacting a change in management for any individual patient.](https://pbs.twimg.com/media/FeOt3cqXoAAEFph.jpg?name=orig)
ALT Risk of chronic kidney disease (CKD) progression, frequency of visits, and referral to nephrology according to glomerular filtration rate (GFR) and albuminuria. The numbers in the boxes are a guide to the frequency of screening or monitoring (number of times per year). Green reflects no evidence of CKD by eGFR or albuminuria, with screening indicated once per year. For monitoring of prevalent CKD, suggested monitoring varies from once per year (yellow) to 4 times or more per year (i.e., every 1–3 months, [deep red]) according to risks of CKD progression and CKD complications. These are general parameters only, based on expert opinion, and underlying comorbid conditions and disease state must be taken into account, as well as the likelihood of impacting a change in management for any individual patient.
ALT Holistic approach for improving outcomes in patients with diabetes and CKD. Icons presented indicate the following benefits: BP cuff, BP-lowering; glucometer, glucose-lowering; heart, cardioprotection; kidney, kidney protection; scale, weight management. eGFR is presented in units of ml/min/1.73 m2. ∗ACEi or angiotensin II receptor blocker (ARB) (at maximal tolerated doses) should be first-line therapy for HTN when albuminuria is present. Otherwise, dihydropyridine CCB or diuretic can also be considered; all 3 classes are often needed to attain BP targets. †Finerenone is currently the only ns-MRA with proven clinical kidney and cardiovascular benefits. ACR, albumin-to-creatinine ratio; ASCVD, atherosclerotic cardiovascular disease; CVD, cardiovascular disease; GLP-1 receptor agonist; MRA, mineralocorticoid receptor antagonist; PCSK9i, proprotein convertase subtilisin/kexin type 9 inhibitor; RAS, renin-angiotensin system; SGLT2i, sodium–glucose cotransporter-2 inhibitor; T1D, T2D.
ALT Overcoming barriers to management of chronic kidney disease (CKD) in patients with diabetes. Barriers such as low CKD awareness, high complexity of care, difficulties with adhering to increasingly complex treatment regimens, and low recognition and application of guideline-directed management all contribute to suboptimal management of patients with diabetes and CKD. Proposed strategies that may contribute to improved management of patients with diabetes and CKD include implementation of multidisciplinary models of care, structured risk mitigation strategies and education, multidisciplinary educational initiatives, harmonization of clinical practice guidelines, and provision of self-management programs for patients with diabetes and CKD.
