Diabetic Kidney Disease

Research on new diabetes medications and their interaction with the kidney has resulted in a shifting diabetic kidney disease (DKD) treatment paradigm. The most recent Kidney Disease Improving Global Outcomes (KDIGO) published in 2020 highlighted these data.(1) The incidence of diabetes has continued to increase across the past 30 years, and DKD is the leading cause of end-stage kidney disease (ESKD) worldwide.(2,3) Implementation of these guidelines may prevent or significantly delay ESKD. Adoption by clinicians of the new KDIGO guidelines is vital given the potential burden of disease in the future. In particular, the efficacy of sodium glucose cotransporter-2 inhibitors (SGLT2i) will be key to reducing the incidence of ESKD in the future (Fig. 1). Despite new medications to fight this battle, there are vast nonrandom variations in geographic distribution of people with diabetes who reach ESKD, thus pointing to environmental and/or genetic factors that may impact disease presentation as well.(4) Chronic kidney disease (CKD) is defined as the presence of kidney damage, physiologic changes, and/or persistently low estimated glomerular filtration rate (eGFR) of less than 60 mL/min per 1.73 m(2) body surface area for more than 3 months.(5) Once CKD is identified, it is staged according to eGFR and the presence and/or amount of albuminuria (Fig. 2).