Oral Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2016

Evolving strategies for the detection, monitoring and management of diabetic kidney disease (#158)

Richard MacIsaac 1
  1. St Vincent's Hospital, St Vincent's Hospital Melbourne, Fitzroy, Vic, Australia

Diabetic kidney disease (DKD) occurs in 25–40% of patients with diabetes. Given the dual problems of a significant risk of progression from DKD to end-stage kidney disease (ESKD) and increased cardiovascular morbidity and mortality, it is important to identify patients at risk of DKD and ESKD and initiate protective renal and cardiovascular therapies. The aim of this presentation is to summarize recent evidence regarding the detection, monitoring and management of DKD. Family history of DKD, smoking history, glycaemic, blood pressure and plasma lipid control are established factors for identifying people at greatest risk of DKD development and progression. Albuminuria and GFR are also important, although albuminuria categorization generally lacks the necessary specificity and sensitivity to identify patients who are at the greatest risk for progressive DKD. The prognostic significance of following trends in GFR trajectories, especially an early decline in GFR has been highlighted in recent studies. However, monitoring renal function decline is compromised by methodological limitations for estimating GFRs in the normal-to-high range. Emerging risk factors for the development and progression of DKD include markers of oxidation and inflammation, profibrotic cytokines, uric acid, advanced glycation end-products, functional and structural markers of vascular dysfunction, kidney structural changes, and tubular biomarkers. Nonetheless, further work is needed to establish whether modulating these factors improves the prognosis for patients with DKD. Changes in the level of urinary peptidome, metabolome and micro RNAs also appear to be promising markers. Empagliflozin, a medication of the sodium glucose like transporter-2 (SGLT-2) inhibitor class has recently been shown to produce clinically meaningful renal protection. The usefulness of endothelin antagonists, non-steroidal mineralocorticoid receptor antagonists and allopurinol as interventions to preserve renal function in patients with diabetes is also currently being investigated.