Diabetic Kidney Disease: A Report From an ADA Consensus Conference

TLDR

Diabetes prevalence has surged worldwide, driving a rise in diabetic kidney disease, which is the leading cause of end‑stage renal disease and imposes enormous healthcare costs. The ADA‑led Consensus Conference was convened to evaluate current practices and chart new directions for managing diabetic kidney disease. The conference addressed seven key areas, including early detection and monitoring, cardiovascular and lipid management, hypertension and RAS/mineralocorticoid blockade, glycemic control and hypoglycemia, nutrition and advanced CKD care, pediatric considerations, and multidisciplinary care models. The resulting state‑of‑the‑art summary and research agenda aim to improve patient outcomes and advance knowledge in diabetic kidney disease.

Abstract

The incidence and prevalence of diabetes mellitus have grown significantly throughout the world, due primarily to the increase in type 2 diabetes. This overall increase in the number of people with diabetes has had a major impact on development of diabetic kidney disease (DKD), one of the most frequent complications of both types of diabetes. DKD is the leading cause of end-stage renal disease (ESRD), accounting for approximately 50% of cases in the developed world. Although incidence rates for ESRD attributable to DKD have recently stabilized, these rates continue to rise in high-risk groups such as middle-aged African Americans, Native Americans, and Hispanics. The costs of care for people with DKD are extraordinarily high. In the Medicare population alone, DKD-related expenditures among this mostly older group were nearly $25 billion in 2011. Due to the high human and societal costs, the Consensus Conference on Chronic Kidney Disease and Diabetes was convened by the American Diabetes Association in collaboration with the American Society of Nephrology and the National Kidney Foundation to appraise issues regarding patient management, highlighting current practices and new directions. Major topic areas in DKD included 1) identification and monitoring, 2) cardiovascular disease and management of dyslipidemia, 3) hypertension and use of renin-angiotensin-aldosterone system blockade and mineralocorticoid receptor blockade, 4) glycemia measurement, hypoglycemia, and drug therapies, 5) nutrition and general care in advanced-stage chronic kidney disease, 6) children and adolescents, and 7) multidisciplinary approaches and medical home models for health care delivery. This current state summary and research recommendations are designed to guide advances in care and the generation of new knowledge that will meaningfully improve life for people with DKD.