Management of Chronic Kidney Disease and End-Stage Renal Disease in Diabetes

Aravind Ganesh, Kovid Lee

ABSTRACT

Diabetic nephropathy occurs in 20–40 % of patients with diabetes mellitus and is the leading cause of End-Stage Renal Disease (ESRD) in North America. This review outlines the evidence-based approach to the management of progressive Chronic Kidney Disease (CKD) and ESRD in diabetes with the objective of guiding future physicians. In addition to patient education on diabetes management, vigilant annual screening for microalbuminuria and increased serum creatinine is the first step towards ensuring early treatment of CKD, well before the onset of frank proteinuria. In addition to controlling hyperglycemia, issues of hypertension and dyslipidemia should be addressed to prevent onset and progression of CKD, with Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers being the drugs of choice for controlling hypertension in these patients and statins being the pharmacological mainstay for dyslipidemia. Furthermore, clinicians must address the consequences of CKD, particularly anemia, hyperphosphatemia, and vitamin D deficiency. Lifestyle modifications such as a low protein diet, smoking cessation, and cardiovascular and resistance exercises could help prevent progression and morbidity in CKD. When patients progress to irreversible kidney failure or ESRD, early (pre-emptive) transplantation before the initiation of dialysis has been shown to maximize survival. Owing to lower risk and better preservation of residual kidney function, peritoneal dialysis is now recommended as the initial modality of dialysis in most ESRD patients in the absence of a kidney transplant. Ultimately, effective management of kidney disease in diabetes relies on the collaborative efforts of the patient, their support system, and their multi-disciplinary healthcare team.

KEYWORDS: diabetes mellitus; diabetes complications; diabetic nephropathy, kidney diseases; kidney failure; chronic

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Ganesh A, Lee K. Management of Chronic Kidney Disease and End-Stage Renal Disease in Diabetes. UBCMJ. 2011 3(1):13-16.