Expert Insights for PCPs in Managing CKD in T2DM

Abstract

Diabetic kidney disease (DKD) is the most common cause of end-stage renal disease (ESRD) in most developed countries including Singapore. Patients with DKD have a disproportionately higher risk for cardiovascular (CV) events and mortality. A comprehensive strategy is recommended for management of patients with DKD to reduce the risks of kidney disease progression and CV disease. Lifestyle modification, CV risk factor and glycaemic control, and maximum tolerated renin-angiotensin-aldosterone-system (RAAS) blockade form the foundation of DKD care. The kidney-protective effects of sodium-glucose co-transporter 2 (SGLT2) inhibitors are well established by randomised controlled trials (RTCs) in patients with DKD, and are independent of the stage of kidney disease. Glucagon-like peptide-1 receptor agonist (GLP-1RA) is the preferred added agent to metformin and SGLT-2 inhibitor if individualised glycaemic targets are not achieved. In addition, the non-steroidal mineralocorticoid receptor antagonist (MRA) finerenone improves kidney and cardiovascular outcomes in patients with DKD.