ADA Guidelines on Diabetic Kidney Disease

Diabetic kidney disease is the leading cause of end-stage kidney disease, the eighth leading cause of death in a few parts of the world and a major risk factor for cardiovascular disease. An estimated 26 million American adults have chronic kidney disease, often requiring dialysis or a kidney transplant.

In 2016 the American Diabetic Association came up with guideline recommendations on 'Diabetic Kidney Disease.'

The major recommendations of the guidelines are as follows

Screening

• At least once a year, assess urinary albumin (e.g., spot urinary albumin–to–creatinine ratio) and estimated glomerular filtration rate in patients with type 1 diabetes with duration of$5 years, in all patients with type 2 diabetes, and in all patients with comorbid hypertension

Treatment

• Optimize glucose control to reduce the risk or slow the progression of diabetic kidney disease.


• Optimize blood pressure control (,140/90 mmHg) to reduce the risk or slow the progression of diabetic kidney disease.


• For people with non dialysis-dependent diabetic kidney disease, dietary protein intake should be 0.8 g/kg body weight per day (the recommended daily allowance). For patients on dialysis, higher levels of dietary protein intake should be considered.


• Either an ACE inhibitor or an angiotensin receptor blocker is recommended for the treatment of non pregnant patients with diabetes and modestly elevated urinary albumin excretion (30–299 mg/day) B and is strongly recommended for those with urinary albumin excretion $300 mg/day and/or estimated glomerular filtration rate ,60 mL/min/1.73 m2.


• Periodically monitor serum creatinine and potassium levels for the development of increased creatinine or changes in potassium when ACE inhibitors,angiotensin receptor blockers, or diuretics are used.


• Continued monitoring of urinary albumin–to–creatinine ratio in patients with albuminuria treated with an ACE inhibitor or an angiotensin receptor blocker is reasonable to assess the response to treatment and progression of diabetic kidney disease.


• An ACE inhibitor or an angiotensin receptor blocker is not recommended for the primary prevention of diabetic kidney disease in patients with diabetes who have normal blood pressure, normal urinary albumin–to–creatinine ratio(,30 mg/g), and normal estimated glomerular filtration rate.


• When estimated glomerular filtration rate is ,60 mL/min/1.73 m2, evaluate and manage potential complications of chronic kidney disease.


• Patients should be referred for evaluation for renal replacement treatment if they have estimated glomerular filtration rate , 30 mL/min/1.73 m2.


• Promptly refer to a physician experienced in the care of kidney disease for uncertainty about the etiology of kidney disease, difficult management issues, and rapidly progressing kidney disease.

To read the guidelines click on the following link

http://care.diabetesjournals.org/site/misc/2016-Standards-of-Care.pdf