According to CDC estimates from 2023, more than one in seven U.S. adults has chronic kidney disease (CKD). Diabetes is the leading cause of CKD both worldwide and in the U.S., accounting for nearly half of all CKD cases.
Diabetic nephropathy and cardiovascular mortality
“Having chronic kidney disease is a risk factor for cardiovascular disease,” says nephrologist Felipe Naranjo, MD. “Likewise, having diabetes and diabetic nephropathy becomes a substantial risk factor for cardiovascular mortality.”
New therapies for diabetic nephropathy aim to reduce the progression of CKD in people with diabetes. By delaying this progression, providers can decrease their patients’ risk of dying from cardiovascular disease.
Establishing risk early
It’s essential for providers to identify the threat of diabetic nephropathy as early as possible. “The earlier we establish this risk, the better we are able to limit the disease and slow its progression as much as possible,” says Dr. Naranjo. “When providers haven’t established or attempted to mitigate the risk of CKD, patients will most likely end up having end-stage kidney disease.”
End-stage kidney disease requires dialysis or kidney transplantation and carries a high risk of mortality. It also adds substantial costs. In 2022, Medicare spent $86 billion on patients with CKD.
“By establishing the risk earlier, we can better intervene with the goal of slowing the progression of the disease,” says Dr. Naranjo. “What we’re really trying to do is help our patients avoid needing dialysis.”
Identifying diabetic nephropathy
To identify diabetic nephropathy, providers need to:
- Assess the presence and severity of albumin in the urine (albuminuria).
- Evaluate the level of the kidney’s function as early as possible.
- Determine the severity of diabetic nephropathy in patients with Type 2 diabetes as soon as they’re diagnosed.
- Assess the risk in patients with Type 1 diabetes within the first five years after they’re diagnosed.
Guideline-directed medical therapy
Guideline-directed medical therapy for CKD has changed drastically in recent years. “Until around five years ago, there were only a few groups of medications shown to slow the progression of CKD,” says Dr. Naranjo. “But research over the past decade has increased the resources we have available.”
With more medications, providers can now better target multiple aspects of diabetic nephropathy. Guideline-directed medical therapy focuses on:
- Risk identification – recognizing patient-specific factors that could contribute to renal deterioration.
- Risk assessment – evaluating severity of CKD and its potential impact on renal function.
- Therapeutic optimization – adjusting treatment based on an individual’s risk and their disease trajectory.
Treating diabetic nephropathy
It’s important for patients with diabetes to understand that controlling diabetes doesn’t mean their CKD is resolved. “Patients need to know the damage diabetes has already caused to their kidneys is irreversible,” says Dr. Naranjo.
Because this damage is permanent, assessing the risk as early as possible is crucial. “We need to keep reviewing this risk on a regular basis,” says Dr. Naranjo. “We can’t do the assessment once and forget about it. We need to keep checking if the medications we’re using are working, or if we need to reevaluate what we’re doing.”
For providers, this means monitoring albuminuria and kidney function every three to six months. “That way we’re continuing to reassess other risks that could be present and address them,” says Dr. Naranjo.
To refer a patient to the nephrology team at Nebraska Medicine, call 402.559.4015 or fax to 402.559.9504.