Controversies in the Management of Early Stage Diabetic Kidney Disease

Abstract

Diabetic kidney disease (DKD) is a major and increasing worldwide public health concern because it is the leading cause of end-stage renal disease (ESRD) and a high risk for cardiovascular events. A number of interventions if initiated at an early stage of DKD reduce the risk and slow the progression to ESRD. Although significant improvement in management of DKD has been developed, there are certain issues that need to be discussed.  The interventions and controversies in management of DKD will be the focus of this presentation. Various international guidelines and relevant literatures that were published through January 2001 to June 2018 for the recommendations on the management of DKD were reviewed. The ideal glycaemic goal in DKD with estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 has not yet been defined. The targets of blood pressure described among guidelines are variable in a patient with DKD. The role of renin-angiotensin system (RAS) blockers which are advocated commonly in diabetic patients having microalbuminuria without hypertension are controversial. There are disputes regarding the use of RAS blockers in diabetic patients with isolated eGFR <60 mL/min/1.73 m2 to prevent the progression of kidney disease. There are also concerns regarding routine use of aspirin as a primary prevention strategy to reduce cardiovascular events in DKD. Further long-term studies are warranted to clear those issues for the best care of a patient with DKD.