Approach to Chronic Kidney Disease in the Diabetic Patient

Farsad Afshinnia, Frank C. Brosius

Research output: Chapter in Book/Report/Conference proceedingChapter


The diagnosis of diabetic kidney disease (DKD) is generally made clinically, either by increased urinary albumin excretion (>30mg/day) or declining glomerular filtration rate, usually in the presence of diabetic retinopathy. All diabetic patients should undergo annual measurements of serum creatinine concentration (S[Cr]) and urinary albumin concentration and have their estimated glomerular filtration rate (eGFR) calculated. Control of blood glucose to achieve an HbA1c of 7%, and blood pressure aimed at a level less than 130/80mmHg, as tolerated, can delay or prevent onset of DKD. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are first-line treatments in hypertensive and nonhypertensive DKD patients, especially those with increased urinary albumin excretion. The use of sodium-glucose cotransporter 2 inhibitors also prevents DKD progression in patients with both preserved and decreased eGFR. Lipid-lowering therapy is beneficial in the primary prevention of cardiovascular events in DKD patients. Dietary protein restriction should also be considered for DKD patients. All patients with stage 4 or 5 CKD should be evaluated for potential renal replacement therapy (RRT) by a nephrologist. Proper candidates should be prepared for end-stage renal disease therapy by discussing modalities of RRT, including renal transplantation, providing necessary education, creating dialysis access when appropriate, and making necessary referrals.

Original languageEnglish (US)
Title of host publicationChronic Renal Disease
Number of pages17
ISBN (Electronic)9780128158760
ISBN (Print)9780128158777
StatePublished - Jan 1 2019
Externally publishedYes


  • Albuminuria
  • Diabetes
  • Diabetic kidney disease
  • Hypertension
  • Lipid control
  • Outcome
  • Primary prevention
  • Screening
  • Sugar control

ASJC Scopus subject areas

  • General Agricultural and Biological Sciences
  • General Biochemistry, Genetics and Molecular Biology


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