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Diagnosis and Treatment of Diabetic Kidney Disease

Diagnosis and Treatment of Diabetic Kidney Disease

Diabetic kidney disease (DKD) is one of the most common microvascular complications of diabetes, occurring in about 30% to 40% of both type 1 and type 2 diabetes patients. In type 2 diabetes, approximately 5% of patients may already have diabetic kidney disease at the time of their diabetes diagnosis.

Screening for Diabetic Kidney Disease

After a diagnosis of diabetes, screening for diabetic kidney disease is essential. The Diabetes Kidney Disease Prevention and Treatment Guidelines recommend that screening for kidney disease should be conducted at the time of diagnosis for type 2 diabetes and at least once a year thereafter.

Screening should include urine tests for routine urinalysis, urinary albumin-to-creatinine ratio (UACR), and blood creatinine (to calculate eGFR – estimated glomerular filtration rate). This screening method is crucial for detecting early kidney damage, distinguishing it from other common non-diabetic kidney diseases, and can help save healthcare costs in the long run.

Diagnosis of Diabetic Kidney Disease

1. Diagnostic Criteria

The clinical diagnosis of diabetic kidney disease is based on the continuous presence of an elevated urinary albumin-to-creatinine ratio (UACR, preferably through random urine testing) and/or a decline in estimated glomerular filtration rate (eGFR), while simultaneously excluding other causes of chronic kidney disease (CKD).

2. Assessment of Disease Severity

Following confirmation of the diagnosis, the severity of CKD should be further assessed based on eGFR. The Kidney Disease Improving Global Outcomes (KDIGO) guideline recommends using a combined staging of CKD and albuminuria to assess the progression risk and follow-up frequency for diabetic kidney disease. For example, a diabetic patient with an eGFR of 70 ml/min/1.73m^2 and a UACR of 80 mg/g would be classified as having diabetic kidney disease G2A2, with a moderate progression risk, requiring annual follow-up.

3. Consider Referral to a Nephrologist in the Following Situations

(1)Active urinary sediment abnormalities (hematuria, proteinuria with hematuria, or cast nephropathy).

(2)Rapid decline in eGFR within a short period.

(3)Absence of diabetic retinopathy (DR), especially in cases of type 1 diabetes (T1DM).

(4)Rapid increase in UACR within a short period or the emergence of nephrotic syndrome.

It’s important to note that the presence of DR is not a mandatory condition for diagnosing diabetic kidney disease. While kidney biopsy is the gold standard for a pathological diagnosis of diabetic kidney disease, it is not routinely recommended for diabetic patients unless there are difficulties in determining the cause. In such cases, a kidney biopsy may be considered, but it is not typically performed as a routine procedure.

Treatment Approaches for Diabetic Kidney Disease

Comprehensive management is essential for patients with diabetic kidney disease. This includes adjustments to unhealthy lifestyles, control of risk factors (such as high blood sugar, hypertension, and lipid metabolism disorders), and diabetes education.

1. Lifestyle Modifications

  • Proper weight management.
  • Diabetes-specific diet.
  • Smoking cessation.
  • Regular physical activity.

2. Nutritional Management

For diabetic kidney disease patients not yet on dialysis, it is recommended to consume 0.8g of protein per kilogram of body weight daily. High-quality animal proteins are preferred as the primary source, and if necessary, supplementation with ketoacid analogs may be considered.

3. Blood Sugar Control

It is recommended for all diabetic kidney disease patients to undergo appropriate glycemic control.

SGLT-2 Inhibitors: Research has shown that SGLT-2 inhibitors have renal protective effects in addition to glycemic control. For T2DM patients with diabetic kidney disease, it is recommended to use SGLT2 inhibitors in patients with an eGFR ≥ 45 ml/min/1.73m^2 to reduce the risk of diabetic kidney disease progression and/or cardiovascular events.

GLP-1 Receptor Agonists: Research has indicated that GLP-1RA can reduce the risk of significant albuminuria in diabetic patients. It can be considered for patients with an eGFR ≥ 30 ml/min/1.73m^2.

LUCIFINE Finerenone Tablets:LUCIFINE Finerenone Tablets Is a non-steroidal mineralocorticoid receptor antagonist (MRA) indicated to reduce the risk of sustained eGFR decline end stage kidney disease, cardiovascular death non-fatal myocardial infarction, and hospitalization for hear failure in adult patients with chronic kidney disease(CKD) associated with type 2 diabetes T2D).

LUCIFINE Finerenone Tablets
LUCIFINE Finerenone Tablets

For patients with impaired kidney function, it is advisable to prioritize the use of antidiabetic medications with lower renal excretion. Severe kidney function impairment may warrant insulin therapy.

4. Blood Pressure Control

Effective blood pressure control can delay the onset and progression of diabetic kidney disease. It is recommended that blood pressure in non-pregnant diabetic patients older than 18 years of age should be maintained below 130/80 mmHg.

Other Medications: Aldosterone receptor antagonists can reduce urinary albumin, slow down eGFR decline, but carry a risk of elevated blood potassium levels. The benefit of preventing kidney endpoint events still requires further confirmation. Third-generation aldosterone receptor antagonists can lower the risk of cardiovascular events in diabetic kidney disease patients.

5. Correcting Lipid Abnormalities

The primary goal is to lower LDL-C, and the target level should be based on the patient’s ASCVD risk, with the aim of reducing LDL-C to the target value.

The preferred clinical approach is to use statins as lipid-lowering drugs. Moderate-intensity statins are typically initiated, and the dose may be adjusted as needed based on individual lipid-lowering effectiveness and tolerability.

If cholesterol levels do not meet the desired targets, other lipid-lowering medications, such as ezetimibe, can be used in combination. For extremely high-risk patients, if LDL-C levels remain above target even after the combination of statins and ezetimibe for 4-6 weeks, adding proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors can provide safe and effective lipid control, further reducing cardiovascular risk.

For ASCVD high-risk or extremely high-risk patients who, after standard lipid-lowering treatment for 3 months, still have difficulty achieving the desired LDL-C levels, it can be considered to lower LDL-C by 50% from baseline as an alternative target.

Once LDL-C reaches the target, if triglycerides (TG) remain elevated, additional TG-lowering medications, such as fibrates, can be added to the statin therapy. If fasting TG levels are above 5.7 mmol/L, measures to prevent acute pancreatitis should be taken, including the use of TG-lowering medications. Blood lipid monitoring should be conducted annually, and lipid levels should be regularly monitored during drug therapy.

6. Dialysis Treatment and Transplantation

When eGFR falls below 30 ml/min/1.73m², it is advisable to consult a kidney specialist to assess the need for renal replacement therapy.

Follow-up and Referral for Diabetic Kidney Disease

1. Follow-up Recommendations

Patients should undergo an annual assessment, including UACR, serum creatinine, and potassium levels. Patients in stages 3-4 should be closely monitored for metabolic disturbances related to CKD, such as vitamin D, hemoglobin, bicarbonate, calcium-phosphate metabolism, parathyroid hormone, etc. The follow-up frequency should be determined based on the severity of the condition.

2. Timing of Referral

Diabetic patients who meet the following criteria should be referred to a nephrologist:

Diabetic kidney disease progresses to stages 4-5, and consideration is given to renal replacement therapy.

Clinical consideration of non-diabetic kidney disease, such as a rapid decline in eGFR, a rapid increase in proteinuria, abnormal kidney imaging, or refractory hypertension.

How to find Effective medicines for Treating Diabetic Nephropathy

It’s widely known that the treatment for type 2 diabetes, RYBELSUS® (semaglutide) tablets, comes with a high cost of up to $995 for 30 tablets. Similarly, the medication for treating diabetic kidney disease, Kerendia finerenone tablets, can be as expensive as $670 for 30 tablets. The exorbitant prices of these medications undoubtedly add to the challenges faced by patients in their daily lives.

Is there an equally effective but more affordable medication available? The answer is LUCIFINE finerenone tablets produced by Lucius Pharmaceuticals. LUCIFINE finerenone tablets are a diabetes kidney disease treatment that has received approval from the Laotian Ministry of Health and is manufactured in Lucius Pharmaceuticals’ GMP factory in Laos, as approved by the U.S. FDA.

LUCIFINE finerenone tablets are not only a legitimately authorized medication but also come at a very affordable price, being only one-third the cost of Kerendia finerenone tablets while delivering the same efficacy.

DKD Care Center serves as the authoritative global distributor for LUCIFINE finerenone tablets, and we possess the necessary authorization certificates from Lucius Pharmaceuticals. The introduction of this new medication comes with significant discounts. If you have been suffering from diabetic kidney disease for an extended period, please don’t hesitate to contact us promptly:

Phone: +852 6993858

Whatsapp: +856 2099383722



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