Diabetic Kidney Disease: A Report From an ADA Consensus Conference

doi:10.1053/j.ajkd.2014.08.001

American Journal of Kidney Diseases

Volume 64, Issue 4, October 2014, Pages 510-533

https://doi.org/10.1053/j.ajkd.2014.08.001 Get rights and content

The incidence and prevalence of diabetes mellitus have grown significantly throughout the world, due primarily to the increase in type 2 diabetes. This overall increase in the number of people with diabetes has had a major impact on development of diabetic kidney disease (DKD), one of the most frequent complications of both types of diabetes. DKD is the leading cause of end-stage renal disease (ESRD), accounting for approximately 50% of cases in the developed world. Although incidence rates for ESRD attributable to DKD have recently stabilized, these rates continue to rise in high-risk groups such as middle-aged African Americans, Native Americans, and Hispanics. The costs of care for people with DKD are extraordinarily high. In the Medicare population alone, DKD-related expenditures among this mostly older group were nearly $25 billion in 2011. Due to the high human and societal costs, the Consensus Conference on Chronic Kidney Disease and Diabetes was convened by the American Diabetes Association in collaboration with the American Society of Nephrology and the National Kidney Foundation to appraise issues regarding patient management, highlighting current practices and new directions. Major topic areas in DKD included (1) identification and monitoring, (2) cardiovascular disease and management of dyslipidemia, (3) hypertension and use of renin-angiotensin-aldosterone system blockade and mineralocorticoid receptor blockade, (4) glycemia measurement, hypoglycemia, and drug therapies, (5) nutrition and general care in advanced-stage chronic kidney disease, (6) children and adolescents, and (7) multidisciplinary approaches and medical home models for health care delivery. This current state summary and research recommendations are designed to guide advances in care and the generation of new knowledge that will meaningfully improve life for people with DKD.

Section snippets

Laboratory Assessment of DKD

Identifying and monitoring DKD relies upon assessments of kidney function, usually with an estimated GFR (eGFR) < 60 mL/min/1.73 m², and kidney damage, usually by estimation of albuminuria > 30 mg/g creatinine. Widespread utilization of these simple laboratory measures has facilitated earlier recognition of DKD and has formed the basis for clinical staging. However, understanding the imprecision associated with these tests is critical to their appropriate utilization in clinical care.

Limitations of eGFR

Routine

Cardiovascular Risks of DKD

Among patients with diabetes, those with kidney disease are consistently observed to have substantially elevated mortality rates.²⁶ Much of this mortality is due to CVD, although noncardiovascular mortality is also increased. Albuminuria and eGFR are independently and additively associated with increased risks of CVD events, CVD mortality, and all-cause mortality.²⁶ Both diabetes and CKD have been observed to have incidence rates of CVD events similar to patients with established coronary heart

Hypertension

Based on the most recent Joint National Committee (JNC) 8 and KDIGO guidelines, BP levels in diabetes are recommended to be below 140/90 mm Hg38, 39 in order to reduce CVD mortality and slow CKD progression. The support for these BP levels is derived from a limited number of randomized trials among patients with diabetes with a focus on CVD event outcomes. However, there are no randomized controlled trials of BP levels that examine CKD events. The data that support the BP level of < 140/90 mm Hg to

Glycemia Measurement

HbA_1c has limitations in the general population and is even less precise in the setting of DKD.⁶¹ In the typical 120-day life cycle of a red blood cell, the HbA_1c reflects time-averaged exposure to glucose. Accelerated red blood cell turnover is a major cause of imprecision of HbA_1c. Erythrocyte survival times become shorter as eGFR falls, resulting in lower HbA_1c. Glycation rate can also be influenced by temperature, acid-base balance, and hemoglobin concentration.⁶² Onset of anemia associated

Nutritional Therapy

For the goals of reducing DKD onset and progression, approaches to nutritional therapy are a subject of much debate. Extensive discussion of dietary management in diabetes and obesity is beyond the scope of this review. Instead, the focus is on extremes of macronutrient intake that have been associated with adverse outcomes, followed by assessment of concepts for healthful eating that are supported by clinical evidence relevant to DKD. It is well recognized that very low-protein diets can lead

Risks of Hypertension and DKD

Historically, it was assumed that diabetes complications primarily affected adults with long-standing and/or poorly controlled disease and spared children with recent-onset disease. A paucity of clinical research in the pediatric population perpetuated this assumption. However, recent studies contradict those tenets and paint a remarkably different picture. The multicenter Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study prospectively evaluated the incidence,

Multidisciplinary Approaches for Comprehensive Care

Optimal care for patients with DKD is complex and best managed using comprehensive multifactorial risk-reduction strategies.160, 161 There is a growing consensus that patient outcomes are most improved with simultaneous control of BP, glucose, and lipids; use of antiplatelet agent therapy when indicated; and lifestyle modifications that include smoking cessation, a healthy diet, exercise, and weight reduction among those who are overweight or obese.4, 20 Smoking is associated with progressive

Conclusions

DKD has emerged as a major aftermath of the worldwide diabetes pandemic. Therefore, diabetes prevention must remain at the cornerstone of reducing DKD. Identification of DKD depends upon screening for increased albuminuria and low eGFR. Both measurements have considerable imprecision, highlighting the need for better identification methods, especially for people at high risk of DKD complications. Prevention of CVD, a major cause of death in DKD, centers upon management of LDL cholesterol and

Acknowledgments

The American Diabetes Association (ADA) thanks Drs Tuttle and Molitch for serving as co-chairs for the Consensus Conference on Chronic Kidney Disease and Diabetes, held March 20-22, 2014. ADA also thanks the ASN (Tod Ibrahim, Phillip Kokemueller, Uptal D. Patel [liaison]), and the NKF (Emily Howell, Kerry Willis, George L. Bakris [liaison]) for participating in the conference as collaborators. The authors thank ADA staff members Erika Gebel Berg, PhD, for significant editorial contributions and

References (190)

F.A. Holtkamp et al.
An acute fall in estimated glomerular filtration rate during treatment with losartan predicts a slower decrease in long-term renal function
Kidney Int
(2011)
F. Ismail-Beigi et al.
Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type 2 diabetes: an analysis of the ACCORD randomised trial
Lancet
(2010)
C.S. Fox et al.
Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis
Lancet
(2012)
M. Tonelli et al.
Risk of coronary events in people with chronic kidney disease compared with those with diabetes: a population-level cohort study
Lancet
(2012)
C. Wanner et al.
KDIGO clinical practice guideline for lipid management in CKD: summary of recommendation statements and clinical approach to the patient
Kidney Int
(2014)
H. Holdaas et al.
Long-term cardiac outcomes in renal transplant recipients receiving fluvastatin: the ALERT extension study
Am J Transplant
(2005)
M. Jun et al.
Effects of fibrates in kidney disease: a systematic review and meta-analysis
J Am Coll Cardiol
(2012)
J.-C. Ansquer et al.
Effect of fenofibrate on kidney function: a 6-week randomized crossover trial in healthy people
Am J Kidney Dis
(2008)
D.C. Wheeler et al.
Summary of KDIGO guideline. What do we really know about management of blood pressure in patients with chronic kidney disease?
Kidney Int
(2013)
S.J. Taler et al.
KDOQI US commentary on the 2012 KDIGO clinical practice guideline for management of blood pressure in CKD
Am J Kidney Dis
(2013)

J.F.E. Mann et al.

Renal Outcomes With Telmisartan, Ramipril, or Both, in People at High Vascular Risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial

Lancet

(2008)

J.D. Bisognano et al.

Baroreflex activation therapy lowers blood pressure in patients with resistant hypertension: results from the double-blind, randomized, placebo-controlled rheos pivotal trial

J Am Coll Cardiol

(2011)

A. Ansari et al.

Assessing glycemic control in patients with diabetes and end-stage renal failure

Am J Kidney Dis

(2003)

F.E. Vos et al.

Red blood cell survival in long-term dialysis patients

Am J Kidney Dis

(2011)

A.I. Adler et al.

Development and progression of nephropathy in type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS 64)

Kidney Int

(2003)

R. Rachmani et al.

Metformin in patients with type 2 diabetes mellitus: reconsideration of traditional contraindications

Eur J Intern Med

(2002)

T. Nagai et al.

Hypoglycemia due to nateglinide administration in diabetic patient with chronic renal failure

Diabetes Res Clin Pract

(2003)

K.R. Tuttle et al.

Effects of exenatide on kidney function, adverse events, and clinical end points of kidney disease in type 2 diabetes

Am J Kidney Dis

(2013)

I.H. de Boer et al.

Temporal trends in the prevalence of diabetic kidney disease in the United States

JAMA

(2011)

A.J. Collins et al.

US Renal Data System 2013 annual data report

Am J Kidney Dis

(2014)

A.J. Collins et al.

US Renal Data System 2013 annual data report

Am J Kidney Dis

(2014)

KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease

Am J Kidney Dis

(2007)

G.M. Magee et al.

Is hyperfiltration associated with the future risk of developing diabetic nephropathy? A meta-analysis

Diabetologia

(2009)

R. Zatz et al.

Prevention of diabetic glomerulopathy by pharmacological amelioration of glomerular capillary hypertension

J Clin Invest

(1986)

M. Evans et al.

Irbesartan delays progression of nephropathy as measured by estimated glomerular filtration rate: post hoc analysis of the Irbesartan Diabetic Nephropathy Trial

Nephrol Dial Transplant

(2012)

G.L. Bakris et al.

Microalbuminuria as a risk predictor in diabetes: the continuing saga

Diabetes Care

(2014)

R. Bilous

Microvascular disease: what does the UKPDS tell us about diabetic nephropathy?

Diabet Med

(2008)

R. Nosadini et al.

Course of renal function in type 2 diabetic patients with abnormalities of albumin excretion rate

Diabetes

(2000)

R.J. MacIsaac et al.

Nonalbuminuric renal insufficiency in type 2 diabetes

Diabetes Care

(2004)

F. He et al.

Diabetic retinopathy in predicting diabetic nephropathy in patients with type 2 diabetes and renal disease: a meta-analysis

Diabetologia

(2013)

L.M. Bachmann et al.

State of the art for measurement of urine albumin: comparison of routine measurement procedures to isotope dilution tandem mass spectrometry

Clin Chem

(2014)

Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy

Lancet

(2000)

A. Patel et al.

Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes

N Engl J Med

(2008)

R.W. Bilous et al.

Renin angiotensin system blockade is effective in preventing microalbuminuria in hypertensive but not normotensive people with type 2 diabetes; further analysis of the DIRECT Programme

(2010)

S.H. Saydah et al.

Albuminuria prevalence in first morning void compared with previous random urine from adults in the National Health and Nutrition Examination Survey, 2009-2010

Clin Chem

(2013)

B.A. Perkins et al.

Regression of microalbuminuria in type 1 diabetes

N Engl J Med

(2003)

Standards of medical care in diabetes—2014

Diabetes Care

(2014)

National Kidney Disease Education Program. Available from: http://nkdep.nih.gov/. Accessed 19...

KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease

Kidney Int

(2013)

P. Rossing

Prediction, progression and prevention of diabetic nephropathy. The Minkowski Lecture 2005

Diabetologia

(2006)

A. Qaseem et al.

Screening, monitoring, and treatment of stage 1 to 3 chronic kidney disease: A clinical practice guideline from the American College of Physicians

Ann Intern Med

(2013)

P.-H. Groop et al.

The presence and severity of chronic kidney disease predicts all-cause mortality in type 1 diabetes

Diabetes

(2009)

M. Afkarian et al.

Kidney disease and increased mortality risk in type 2 diabetes

J Am Soc Nephrol

(2013)

K. Borch-Johnsen et al.

The effect of proteinuria on relative mortality in type 1 (insulin-dependent) diabetes mellitus

Diabetologia

(1985)

M. Tonelli et al.

Association between LDL-C and risk of myocardial infarction in CKD

J Am Soc Nephrol

(2013)

S.C. Palmer et al.

Benefits and harms of statin therapy for persons with chronic kidney disease: a systematic review and meta-analysis

Ann Intern Med

(2012)

R. Haynes et al.

Effects of lowering LDL cholesterol on progression of kidney disease

J Am Soc Nephrol

(2014)

P.A. James et al.

2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8)

JAMA

(2014)

V. Pogue et al.

Disparate estimates of hypertension control from ambulatory and clinic blood pressure measurements in hypertensive kidney disease

Hypertension

(2009)

F.H. Messerli et al.

Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous?

Ann Intern Med

(2006)

Cited by (434)

The redox-sensitive GSK3β is a key regulator of glomerular podocyte injury in type 2 diabetic kidney disease
2024, Redox Biology
Emerging evidence suggests that GSK3β, a redox-sensitive transducer downstream of insulin signaling, acts as a convergent point for myriad pathways implicated in kidney injury, repair, and regeneration. However, its role in diabetic kidney disease remains controversial. In cultured glomerular podocytes, exposure to a milieu of type 2 diabetes elicited prominent signs of podocyte injury and degeneration, marked by loss of homeostatic marker proteins like synaptopodin, actin cytoskeleton disruption, oxidative stress, apoptosis, and stress-induced premature senescence, as shown by increased staining for senescence-associated β-galactosidase activity, amplified formation of γH2AX foci, and elevated expression of mediators of senescence signaling, like p21 and p16^INK4A. These degenerative changes coincided with GSK3β hyperactivity, as evidenced by GSK3β overexpression and reduced inhibitory phosphorylation of GSK3β, and were averted by tideglusib, a highly-selective small molecule inhibitor of GSK3β. In agreement, post-hoc analysis of a publicly-available glomerular transcriptomics dataset from patients with type 2 diabetic nephropathy revealed that the curated diabetic nephropathy-related gene set was enriched in high GSK3β expression group. Mechanistically, GSK3β-modulated nuclear factor Nrf2 signaling is involved in diabetic podocytopathy, because GSK3β knockdown reinforced Nrf2 antioxidant response and suppressed oxidative stress, resulting in an improvement in podocyte injury and senescence. Conversely, ectopic expression of the constitutively active mutant of GSK3β impaired Nrf2 antioxidant response and augmented oxidative stress, culminating in an exacerbated diabetic podocyte injury and senescence. Moreover, IRS-1 was found to be a cognate substrate of GSK3β for phosphorylation at IRS-1^S332, which negatively regulates IRS-1 activity. GSK3β hyperactivity promoted IRS-1 phosphorylation, denoting a desensitized insulin signaling. Consistently, in vivo in db/db mice with diabetic nephropathy, GSK3β was hyperactive in glomerular podocytes, associated with IRS-1 hyperphosphorylation, impaired Nrf2 response and premature senescence. Our finding suggests that GSK3β is likely a novel therapeutic target for treating type 2 diabetic glomerular injury.
Polypharmacy in chronic kidney disease: Health outcomes & pharmacy-based strategies to mitigate inappropriate polypharmacy
2024, American Journal of the Medical Sciences
The rising prevalence of comorbidities in an increasingly aging population has sparked a reciprocal rise in polypharmacy. Patients with chronic kidney disease (CKD) have a greater burden of polypharmacy due to the comorbidities and complications associated with their disease. Polypharmacy in CKD patients has been linked to myriad direct and indirect costs for patients and the society at large. Pharmacists are uniquely positioned within the healthcare team to streamline polypharmacy management in the setting of CKD. In this article, we review the landscape of polypharmacy and examine its impacts through the lens of the ECHO model of Economic, Clinical, and Humanistic Outcomes. We also present strategies for healthcare teams to improve polypharmacy care through comprehensive medication management process that includes medication reconciliation during transitions of care, medication therapy management, and deprescribing. These pharmacist-led interventions have the potential to mitigate adverse outcomes associated with polypharmacy in CKD.
Dose-dependent anti-hyperglycemic & anti-dyslipidemic potential of aqueous leaves extract of Typha elephantina in-vivo and in-vitro
2023, Saudi Journal of Biological Sciences
Diabetes mellitus is among the fundamental causes of illness and millions of deaths around the globe are directly attributed to it each year. Current antidiabetic medications often lack sustained glycemic control and carry significant risks of side effects. As a result, the use of plant-based treatments has gained popularity. In this experimental study, we evaluated the aqueous extracts (LQE) of Typha elephantina (also known as Elephant grass) leaves collected from freshwater marshes, for their potential anti-hyperglycemic and anti-hyperlipidemic antioxidant effects in healthy streptozotocin caused diabetic-mice. We employed glucose adsorption tests at different glucose levels and glucose diffusion tests to assess the in-vitro antidiabetic action of plant extract. For the in-vivo trail, we measured fasting blood glucose (FBG), glucose tolerance (GTT), as well as long-term anti-diabetic, anti-hyperlipidemic, and antioxidant activities. Our results from the glucose diffusion test indicated that the extract was highly effective at both low glucose concentrations (5 mmol L) and high glucose concentrations (100 mmol L). However, the glucose-diffusion ability reached its peaked at an excessively high dosage of the aqueous extract, suggesting a dose-related effect. Similarly, we observed that high doses of TEL.AQ extracts (400 mg/kg body weight) significantly reduced blood glucose levels in healthy mice during the glucose tolerance test (GTT) at 3 h and fasting blood glucose studies (FBG) at 6 h. Furthermore, the high-dose TEL.AQ extract effectively reduced liver-related serum markers and blood-glucose concentration (BGC) in severely chronic diabetic rats. The extract dosage also influenced lipid profile, conjugate and unconjugated bilirubin levels, cholesterol, triglycerides, HDL, and total bilirubin levels. Additionally, after administering a high extract dose, we observed considerable improvement in the liver homogenate markers CAT, POD, and SOD. In contrast, the extract at a low dosage (100 mg/kg), showed minimal, while a moderate dose (200 mg/kg), yielded promising results.
Association of eGFR slope with all-cause mortality, macrovascular and microvascular outcomes in people with type 2 diabetes and early-stage chronic kidney disease
2023, Diabetes Research and Clinical Practice
The association of estimated glomerular filtration rate (eGFR) slope with progression of complications in people with type 2 diabetes (T2D) and early-stage chronic kidney disease (CKD) is less clear.
We identified 115,139 T2D participants without decreased eGFR (>60 mL/min/1.73 m²) between 2008 and 2015 from the electronic database of the Hong Kong Hospital Authority. eGFR slope calculated by linear-mixed effects model using 3-year eGFR measurements was categorized into quintiles. With Quintile 3 of eGFR slope as the reference group, we used Cox proportional or cause-specific models to investigate the association between eGFR slope and all-cause mortality, macrovascular and microvascular complications, as appropriate.
Over a median follow-up of 7.8 years, fastest eGFR declines (Quintile 1 with median eGFR slope: −4.32 mL/min/1.73 m²/year) were associated with increased risk of all adverse outcomes (adjusted hazard ratio [aHR] 1.36 to 2.97, all P < 0.0001), compared with less steep eGFR declines (Quintile 3: −1.08 mL/min/1.73 m²/year). Substantial eGFR increases (Quintile 5: 1.34 mL/min/1.73 m²/year) were associated with decreased risk of CKD and ≥ 40 % decline in eGFR (aHR [95 % CI] 0.65 [0.63, 0.67] and 0.85 [0.82, 0.89], respectively) and higher risk of death, CVD, DR and DN (aHR [95 % CI] 1.48 [1.40, 1.56], 1.19 [1.14, 1.25], 1.07 [1.004, 1.15] and 1.62 [1.37, 1.91], respectively).
In a cohort of T2D people without decreased eGFR, accelerated declines and increases in eGFR were associated with all-cause mortality, macrovascular and microvascular complications, supporting the potential prognostic utility of eGFR slope in T2D people with early-stage CKD.
Identification of urinary extracellular vesicles differentially expressed RNAs in diabetic nephropathy via whole-transcriptome integrated analysis
2023, Computers in Biology and Medicine
Diabetic nephropathy (DN) is a common systemic microvascular complication of diabetes and a leading cause of chronic kidney disease worldwide. Urinary extracellular vesicles (uEVs), which are natural nanoscale vesicles that protect RNA from degradation, have the potential to serve as an invasive diagnostic biomarker for DN.
We enrolled 24 participants, including twelve with renal biopsy-proven T₂DN and twelve with T₂DM, and isolated uEVs using ultracentrifugation. We performed microarrays for mRNAs, lncRNAs, and circRNAs in parallel, and Next-Generation Sequencing for miRNAs. Differentially expressed RNAs (DE-RNAs) were subjected to CIBERSORTx, ssGSEA analysis, GO enrichment, PPI network analysis, and construction of the lncRNA/circRNA-miRNA-mRNA regulatory network. Candidate genes and potential biomarker RNAs were validated using databases and machine learning models.
A total of 1684 mRNAs, 126 lncRNAs, 123 circRNAs and 66 miRNAs were found in uEVs in T₂DN samples compared with T₂DM. CIBERSORTx revealed the involvement of uEVs in immune activity and ssGSEA explored possible cell or tissue sources of uEVs. A ceRNA co-expression and regulation relationship network was constructed. Candidate genes MYO1C and SP100 mRNA were confirmed to be expressed in the kidney using Nephroseq database, scRNA-seq dataset, and Human Protein Atlas database. We further selected 2 circRNAs, 2 miRNAs, and 2 lncRNAs from WGCNAs and ceRNAs and demonstrated their efficacy as potential diagnostic biomarkers for T₂DN using machine learning algorithms.
This study reported, for the first time, the whole-transcriptome genetic resources found in urine extracellular vesicles of T₂DN patients. The results provide additional support for the possible interactions, and regulators between RNAs from uEVs themselves and as potential biomarkers in DN.
DsbA-L interacting with catalase in peroxisome improves tubular oxidative damage in diabetic nephropathy
2023, Redox Biology
Peroxisomes are metabolically active organelles that are known for exerting oxidative metabolism, but the precise mechanism remains unclear in diabetic nephropathy (DN). Here, we used proteomics to uncover a correlation between the antioxidant protein disulfide-bond A oxidoreductase-like protein (DsbA-L) and peroxisomal function. In vivo, renal tubular injury, oxidative stress, and cell apoptosis in high-fat diet plus streptozotocin (STZ)-induced diabetic mice were significantly increased, and these changes were accompanied by a "ghost" peroxisomal phenotype, which was further aggravated in DsbA-L-deficient diabetic mice. In vitro, the overexpression of DsbA-L in peroxisomes could improve peroxisomal phenotype and function, reduce oxidative stress and cell apoptosis induced by high glucose (HG, 30 mM) and palmitic acid (PA, 250 μM), but this effect was reversed by 3-Amino-1,2,4-triazole (3-AT, a catalase inhibitor). Mechanistically, DsbA-L regulated the activity of catalase by binding to it, thereby reducing peroxisomal leakage and proteasomal degradation of peroxisomal matrix proteins induced by HG and PA. Additionally, the expression of DsbA-L in renal tubules of patients with DN significantly decreased and was positively correlated with peroxisomal function. Taken together, these results highlight an important role of DsbA-L in ameliorating tubular injury in DN by improving peroxisomal function.

View all citing articles on Scopus

: This article is being published concurrently in Diabetes Care and AJKD. The articles are identical except for stylistic changes in keeping with each journal’s style. Either of these versions may be used in citing this article.

View full text

Special ReportDiabetic Kidney Disease: A Report From an ADA Consensus Conference

Section snippets

Laboratory Assessment of DKD

Limitations of eGFR

Cardiovascular Risks of DKD

Hypertension

Glycemia Measurement

Nutritional Therapy

Risks of Hypertension and DKD

Multidisciplinary Approaches for Comprehensive Care

Conclusions

Acknowledgments

Kidney Int

Lancet

Lancet

Lancet

Kidney Int

Am J Transplant

J Am Coll Cardiol

Am J Kidney Dis

Kidney Int

Am J Kidney Dis

Lancet

J Am Coll Cardiol

Am J Kidney Dis

Am J Kidney Dis

Kidney Int

Eur J Intern Med

Diabetes Res Clin Pract

Am J Kidney Dis

Temporal trends in the prevalence of diabetic kidney disease in the United States

JAMA

US Renal Data System 2013 annual data report

Am J Kidney Dis

US Renal Data System 2013 annual data report

Am J Kidney Dis

KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease

Am J Kidney Dis

Is hyperfiltration associated with the future risk of developing diabetic nephropathy? A meta-analysis

Diabetologia

Prevention of diabetic glomerulopathy by pharmacological amelioration of glomerular capillary hypertension

J Clin Invest

Irbesartan delays progression of nephropathy as measured by estimated glomerular filtration rate: post hoc analysis of the Irbesartan Diabetic Nephropathy Trial

Nephrol Dial Transplant

Microalbuminuria as a risk predictor in diabetes: the continuing saga

Diabetes Care

Microvascular disease: what does the UKPDS tell us about diabetic nephropathy?

Diabet Med

Course of renal function in type 2 diabetic patients with abnormalities of albumin excretion rate

Diabetes

Nonalbuminuric renal insufficiency in type 2 diabetes

Diabetes Care

Diabetic retinopathy in predicting diabetic nephropathy in patients with type 2 diabetes and renal disease: a meta-analysis

Diabetologia

State of the art for measurement of urine albumin: comparison of routine measurement procedures to isotope dilution tandem mass spectrometry

Clin Chem

Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy

Lancet

Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes

N Engl J Med

Renin angiotensin system blockade is effective in preventing microalbuminuria in hypertensive but not normotensive people with type 2 diabetes; further analysis of the DIRECT Programme

Albuminuria prevalence in first morning void compared with previous random urine from adults in the National Health and Nutrition Examination Survey, 2009-2010

Clin Chem

Regression of microalbuminuria in type 1 diabetes

N Engl J Med

Standards of medical care in diabetes—2014

Diabetes Care

KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease

Kidney Int

Prediction, progression and prevention of diabetic nephropathy. The Minkowski Lecture 2005

Diabetologia

Screening, monitoring, and treatment of stage 1 to 3 chronic kidney disease: A clinical practice guideline from the American College of Physicians

Ann Intern Med

The presence and severity of chronic kidney disease predicts all-cause mortality in type 1 diabetes

Diabetes

Kidney disease and increased mortality risk in type 2 diabetes

J Am Soc Nephrol

The effect of proteinuria on relative mortality in type 1 (insulin-dependent) diabetes mellitus

Diabetologia

Association between LDL-C and risk of myocardial infarction in CKD

Special Report
Diabetic Kidney Disease: A Report From an ADA Consensus Conference