Abstract
People with type 1 and type 2 diabetes are at risk of developing progressive chronic kidney disease (CKD) and end-stage kidney failure. Hypertension is a major, reversible risk factor in people with diabetes for development of albuminuria, impaired kidney function, end-stage kidney disease and cardiovascular disease. Blood pressure control has been shown to be beneficial in people with diabetes in slowing progression of kidney disease and reducing cardiovascular events. However, randomised controlled trial evidence differs in type 1 and type 2 diabetes and different stages of CKD in terms of target blood pressure. Activation of the renin-angiotensin-aldosterone system (RAAS) is an important mechanism for the development and progression of CKD and cardiovascular disease. Randomised trials demonstrate that RAAS blockade is effective in preventing/ slowing progression of CKD and reducing cardiovascular events in people with type 1 and type 2 diabetes, albeit differently according to the stage of CKD. Emerging therapy with sodium glucose cotransporter-2 (SGLT-2) inhibitors, non-steroidal selective mineralocorticoid antagonists and endothelin-A receptor antagonists have been shown in randomised trials to lower blood pressure and further reduce the risk of progression of CKD and cardiovascular disease in people with type 2 diabetes. This guideline reviews the current evidence and makes recommendations about blood pressure control and the use of RAAS-blocking agents in different stages of CKD in people with both type 1 and type 2 diabetes.
Highlights
A significant percentage of people with diabetes develop chronic kidney disease (CKD), and diabetes is a leading cause of end-stage kidney disease [1]
We suggest that angiotensin-converting-enzyme inhibitor (ACEI) should be preferentially used in people with type 2 diabetes and CKD who have urine albumin:creatinine ratio (UACR) > 3 mg/mmol (> 26.55 mg/g)
The analysis showed that blood pressure lowering treatment was associated with lower risks of cardiovascular events, all causes of mortality and cardiovascular mortality, and that the effect seemed to Recommendations for hypertension management and renin-angiotensin-aldosterone system (RAAS) blockade in people with diabetes on modialysis
Summary
A significant percentage of people with diabetes develop chronic kidney disease (CKD), and diabetes is a leading cause of end-stage kidney disease [1]. There are few long-term studies that suggest that treating people with type 1 diabetes, microalbuminuria and normal blood pressure reduces end-stage kidney disease.
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