The reduction in UACR from baseline to month 4 was greater with finerenone compared with placebo (31% reduction), and the incidence of the secondary composite kidney outcome (kidney failure, sustained decrease of 57% in the eGFR from baseline [consistent with a doubling of serum creatinine], or death from kidney causes) occurred in fewer patients in the finerenone group (252 patients [8

The reduction in UACR from baseline to month 4 was greater with finerenone compared with placebo (31% reduction), and the incidence of the secondary composite kidney outcome (kidney failure, sustained decrease of 57% in the eGFR from baseline [consistent with a doubling of serum creatinine], or death from kidney causes) occurred in fewer patients in the finerenone group (252 patients [8.9%] vs. agents with different mechanisms of action are also in development that have the potential to further slow or prevent disease progression when used with currently recommended therapies. Chronic kidney disease. Modified from Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group [61], copyright 2013, with permission from Elsevier The preferred method for assessment of albuminuria is the UACR, measured in a random spot urine collection [14]. This method of assessment is easy to perform compared with a 24-h urine collection, which is inconvenient for patients and subject to incomplete collection [16]. Concurrent measurement of urinary creatinine ensures that variations in albumin concentration due to hydration levels do not confound the result. A positive diagnosis of increased urinary albumin excretion, defined as 30?mg/g albumin/creatinine, should only be made when two of three samples collected over a 3- to 6-month period exceed that threshold [14]. It is important to assess both the UACR and the eGFR because albuminuria can predict CKD risk earlier than a decrease in GFR; for example, the UACR can be moderately increased when the eGFR is still normal (Fig.?1) [14, 17]. The eGFR can also be high (eGFR?>?90?mL/min/1.73 m2) due to hyperfiltration, which is common early in diabetes [8] and may mask the degree of kidney damage if eGFR is measured in isolation. Although the importance of albuminuria screening in patients with T2D has been understood for many years, rates of testing remain suboptimal. The US Renal Data System has reported testing trends from 2016 in two populations of patients with T2D and without CKD: a Medicare 5% sample aged??65?years and an Optum Clinformatics sample aged 22C64?years [1]. During that year, less than half of these patients in both the Medicare (42%) and Optum Clinformatics (49%) populations had undergone any urine albumin testing. Furthermore, different methods of assessing albuminuria were used, such as measurement of urinary protein, which has lower sensitivity for predicting kidney events compared with the UACR [18]. Management OF CKD In Patients With T2D Glycemic Control Intensive glycemic control in patients with T2D results in significant reductions in the development of microvascular complications, with the evidence of prevention of incident CKD being stronger than that for decreasing progression of established CKD [19, 20]. Therefore, the ADA guidelines provide treatment goals for glucose control (target levels of glycated hemoglobin [A1C], described in Table ?Table1),1), and recommend that Dipraglurant A1C is assessed at least twice per year in patients meeting these goals, and quarterly in patients who have switched therapy or who are not meeting treatment goals [14]. This approach is Rabbit polyclonal to PELI1 endorsed Dipraglurant in the Kidney Disease Improving Global Outcomes (KDIGO?) 2020 Clinical Practice Guidelines [17]. It is important to note that in patients with Dipraglurant advanced CKD, A1C levels may be falsely low, and therefore patients with T2D and CKD should be encouraged to self-monitor their blood glucose levels more frequently [21]. This is due to patients commonly having anemia of chronic disease, and the decreased survival time of erythrocytes in these patients leads to falsely low A1C results [22]. The incidence of adverse effects associated with intensive glycemic control is increased in patients with concomitant CKD, so careful individualization of glycemic goals is recommended (Table ?(Table1)1) [14]. Table 1 American Diabetes Dipraglurant Association treatment goals and guidance [14] Glycated hemoglobin, American Diabetes Association, blood pressure, chronic kidney disease, cardiovascular disease, type 2 diabetes Dietary Intervention Dietary interventions can help to improve blood pressure (BP).