Diabetic Kidney Disease Management

Diagnosis and Screening

Diabetic kidney disease is defined as persistent albuminuria (UACR >30 mg/g) or persistently reduced eGFR (<60 ml/min/1.73 m²), or both, for greater than 3 months 1
Early detection is critical as diabetic kidney disease is associated with poor quality of life, increased risk of cardiovascular disease, and premature death 2, 3

The American College of Cardiology recommends initiating ACE inhibitor or ARB in patients with diabetes, hypertension, and albuminuria, titrated to the highest approved dose that is tolerated 1
Add SGLT2 inhibitor regardless of glycemic control for kidney and cardiovascular protection 6
Non-steroidal MRAs can be added to the combination of RAS inhibitor and SGLT2 inhibitor for enhanced kidney protection 7

Implement all three core therapies (RAS inhibitor, SGLT2 inhibitor, and non-steroidal MRA) within the first 3 months after diabetic kidney disease diagnosis to maximize kidney protection 6
Monitor disease progression with CKD biomarkers including albuminuria (UACR) and natriuretic peptides 6
Regular monitoring of kidney function, albuminuria, blood pressure, and serum potassium is essential, particularly after medication initiation or dose changes 7, 8

Optimize glycemic control targeting HbA1c <7.0% to decrease microvascular complications 8
Target blood pressure <130/80 mmHg in patients with diabetes and kidney disease 8
Recommend smoking cessation for all patients with diabetes and CKD 7
Implement dietary sodium restriction (<2.3 g/day) to optimize effectiveness of antihypertensive medications 8