Kidney Disease in Diabetic Patients: From Pathophysiology to Pharmacological Aspects with a Focus on Therapeutic Inertia

Abstract

Diabetes mellitus represents a growing concern, both for public economy and global health. In fact, it can lead to insidious macrovascular and microvascular complications, impacting negatively on patients’ quality of life. Diabetic patients often present diabetic kidney disease (DKD), a burdensome complication that can be silent for years. The average time of onset of kidney impairment in diabetic patients is about 7–10 years. The clinical impact of DKD is dangerous not only for the risk of progression to end-stage renal disease and therefore to renal replacement therapies, but also because of the associated increase in cardiovascular events. An early recognition of risk factors for DKD progression can be decisive in decreasing morbidity and mortality. DKD presents patient-related, clinician-related, and system-related issues. All these problems are translated into therapeutic inertia, which is defined as the failure to initiate or intensify therapy on time according to evidence-based clinical guidelines. Therapeutic inertia can be resolved by a multidisciplinary pool of healthcare experts. The timing of intensification of treatment, the transition to the best therapy, and dietetic strategies must be provided by a multidisciplinary team, driving the patients to the glycemic target and delaying or overcoming DKD-related complications. A timely nephrological evaluation can also guarantee adequate information to choose the right renal replacement therapy at the right time in case of renal impairment progression.

Prevalence of Chronic Kidney Disease in Patients with Diabetes in Extremadura (Spain) during the Years 2012, 2013 and 2014: An Observational Study

“…In summary, our study reveals a prevalence of CKD of 25.3% in the diabetic population of Extremadura (Spain), accepting the criteria defined in the K/DOQI clinical practice guidelines of the National Kidney Foundation. On the other hand, the high percentage of patients without eGFR and UACR determinations is in line with the topic of clinical/therapeutic inertia which concerns both nephrologists and diabetologists, since glomerular hyperfiltration and albuminuria are often the first marker of a progression towards CKD [21]. An early recognition of risk factors for CKD progression can be decisive in decreasing morbidity and mortality, and a timely nephrological evaluation can also guarantee adequate information to choose the right renal replacement therapy at the right time in case of renal impairment progression.…”

Cardiorenal Syndrome: New Pathways and Novel Biomarkers

“…There is growing evidence regarding the validation and utility of recent serum and urinary biomarkers for acute and chronic CRS thanks to the harnessing of newer technologies or the development of dedicated protein panels. The use of high specificity and sensitivity tools with high prognostic values can help the clinician to overcome therapeutic limits and create new strategies for the treatment of complex clinical conditions [ 89 , 91 ]. .…”

The Aggressive Diabetic Kidney Disease in Youth-Onset Type 2 Diabetes: Pathogenetic Mechanisms and Potential Therapies

“…The therapeutic approach to DKD is characterized by a series of changes in life habits and, if necessary, a pharmacological treatment to improve glycemic control, hypertension, the lipid profile, and the progression of renal disease [ 141 ]. Among lifestyle changes are included the increase of physical activity, improvement in sleep restoration, and healthy nutrition [ 142 ].…”