Abstract
Diabetic kidney disease (DKD) is one of the most relevant complications of type 2 diabetes and dramatically increases the cardiovascular risk in these patients. Currently, DKD is severely infra-diagnosed, or its diagnosis is usually made at advanced stages of the disease. During the last decade, new drugs have demonstrated a beneficial effect in terms of cardiovascular and renal protection in type 2 diabetes, supporting the crucial role of an early DKD diagnosis to permit the use of new available therapeutic strategies. Moreover, cardiovascular and renal outcome trials, developed to study these new drugs, are based on diverse cardiovascular and renal simple and composite endpoints, which makes difficult their interpretation and the comparison between them. In this article, DKD diagnosis is reviewed, focusing on albuminuria and the recommendations for glomerular filtration rate measurement. Furthermore, cardiovascular and renal endpoints used in classical and recent cardiovascular outcome trials are assessed in a pragmatic way.
Highlights
In patients with type 2 diabetes, the prevalence of chronic kidney disease (CKD)is around 30–40%, mainly secondary to diabetic kidney disease (DKD) [1]
As MACE and its variations are a good strategy for a clinical comparison of cardiovascular outcome trials (CVOTs), so the inclusion of renal outcomes in CVOTs with antidiabetic drugs is fundamental for the rational evaluation of patients with type 2 diabetes
This study demonstrated that empagliflozin consistently reduced the risk of a broad range of kidney composite outcomes using different eGFR thresholds (≥30%, ≥40%, ≥50%, and ≥67%) to define a significant loss of kidney function
Summary
In patients with type 2 diabetes, the prevalence of chronic kidney disease (CKD). is around 30–40%, mainly secondary to diabetic kidney disease (DKD) [1]. The only treatment that partially demonstrated to delay DKD progression has been renin–angiotensin system blockade In these last few years, new therapeutic options, such as sodium–glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1a), have demonstrated a cardio-renal protective effect in type 2 diabetic patients [5,6,7]. The recommendation for these new drugs use has been implemented in several diabetes guidelines written by multidisciplinary teams composed of different specialist such as endocrinologists, nephrologists, internal medicine doctors, and cardiologists. This review has mainly been based on a PubMed search and should be considered as narrative in nature
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