The Landscape of Diabetic Kidney Disease in the United States

Abstract

Purpose of ReviewThe purposes of this review are to identify population characteristics of important risk factors for the development and progression of diabetic kidney disease (DKD) in the United States and to discuss barriers and opportunities to improve awareness, management, and outcomes in patients with DKD.Recent FindingsThe major risk factors for the development and progression of DKD include hyperglycemia, hypertension, and albuminuria. DKD disproportionately affects minorities and individuals with low educational and socioeconomic status. Barriers to effective management of DKD include the following: (a) limited patient and healthcare provider awareness of DKD, (b) lack of timely referrals of patients to a nephrologist, (c) low patient healthcare literacy, and (d) insufficient access to healthcare and health insurance.SummaryIncreased patient and physician awareness of DKD has been shown to enhance patient outcomes. Multifactorial and multidisciplinary interventions targeting multiple risk factors and patient/physician education may provide better outcomes in patients with DKD.Electronic supplementary materialThe online version of this article (10.1007/s11892-018-0980-x) contains supplementary material, which is available to authorized users.

The Familiality of Rapid Renal Decline in Diabetes

“…Like DKD, the pathogenesis of rapid renal decline in diabetes is complex and multifactorial. In addition to major risk factors that include hyperglycemia, hypertension, dyslipidemia, and albuminuria, various environmental factors (e.g., employment status, education level, and access to health care) have all been shown to contribute to DKD risk (46). Additionally, estimates of the heritability (h 2 ), or the proportion of total variation due to genetic effects, of DKD and several DKD-related traits (e.g., urinary albumin excretion rate [AER] and eGFR) have also established that genetic factors contribute to increased risk of DKD in families with diabetes (18,(40)(41)(42)(43)47,48).…”

Serum Klotho protein level in type 2 diabetic patients depending on the renal function

“…(2016) [5]. Згідно статистичним даним, у 30-40 % пацієнтів, які потребують нирково-замісної терапії діалізом, ниркова недостатність є наслідком ДН, поширеність якої продовжує наростати, частково через те, що виживаність хворих на ЦД 2 типу покращилась внаслідок зниження випадків смертності від серцево-судинних подій [6,7] Особливістю ниркових ускладнень у пацієнтів з ЦД 2 типу є гетерогенність патології нирок, що практично не дозволяє диференціювати класичну ДН за визначенням екскреції білка, як при ЦД 1 типу. В даний час з метою діагностики ниркової патології прийнято термін хронічної хвороби нирок (ХХН), який представляє собою узагальнююче поняття і дозволяє оцінити наявність і тяжкість ураження нирок незалежно від причини ушкодження [4,8].…”

Antidiabetic drug use trends in patients with type 2 diabetes mellitus and chronic kidney disease: A cross‐sectional analysis of the National Health and Nutrition Examination Survey

“…In addition, strategies including increasing awareness by education and training, decision support systems, streamlining of prescribing guidelines, coordination of care, and better access to specialists can help reduce inappropriate medication use and ensure better disease management for patients with CKD. [26][27][28] In a study with veteran participants, an intervention targeted at pharmacy leaders following up with providers regarding hypoglycemia with glyburide led to a reduction in its use. 29 In addition to implementation, effectiveness of these programs and support systems should also be evaluated at the institution level for continuous improvement.…”