Transforming the care of patients with diabetic kidney disease

Frank C. Brosius, David Cherney, Patrick O. Gee, Raymond C. Harris, Alan S. Kliger, Katherine R. Tuttle, Susan E. Quaggin

Research output: Contribution to journalArticlepeer-review

Abstract

Diabetes and its associated complications pose an immediate threat to humankind. Diabetic kidney disease is one of the most devastating complications, increasing the risk of death more than ten-fold over the general population. Until very recently, the only drugs proven and recommended to slow the progression of diabetic kidney disease were angiotensin-converting enzyme inhibitors and angiotensin II type 1 receptor blockers, which act by inhibiting the renin-angiotensin system. Despite their efficacy as kidney and cardiovascular protective therapies and as antihypertensive agents, renin-angiotensin system inhibitors have been grossly underutilized.Moreover, even when renin-angiotensin system inhibitors are used, patients still have a high residual risk of diabetic kidney disease progression. Finally, the kidney-protective effect of renin-angiotensin systeminhibitors has been categorically demonstrated only in patients with macroalbuminuria included in the IrbesartanDiabeticNephropathy Trial (IDNT) and Reduction of Endpoints inNIDDMwith the Angiotensin II Antagonist Losartan (RENAAL) trials, not in other individuals.The lack of newtherapies to treat diabetic kidney disease over the past 2 decades has therefore represented a tremendous challenge for patients and health care providers alike. In recent years, a number of powerful new therapies have emerged that promise to transform care of patients with diabetes and kidney disease. The challenge to the community is to ensure rapid implementation of these treatments. This white paper highlights advances in treatment, opportunities for patients, challenges, and possible solutions to advance kidney health, and introduces the launch of the Diabetic Kidney Disease Collaborative at the American Society of Nephrology, to aid in accomplishing these goals.

Original languageEnglish (US)
Pages (from-to)1590-1600
Number of pages11
JournalClinical Journal of the American Society of Nephrology
Volume16
Issue number10
DOIs
StatePublished - Oct 2021
Externally publishedYes

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

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