Diabetes Metab J.  2024 Mar;48(2):196-207. 10.4093/dmj.2023.0244.

Risk Prediction and Management of Chronic Kidney Disease in People Living with Type 2 Diabetes Mellitus

• Ooi YG
• Sarvanandan T
• Hee NKY
• Lim QH
• Paramasivam SS
• Ratnasingam J
• Vethakkan SR
• Lim SK
• Lim LL

• KMID: 2553590
• DOI: http://doi.org/10.4093/dmj.2023.0244

Abstract

People with type 2 diabetes mellitus have increased risk of chronic kidney disease and atherosclerotic cardiovascular disease. Improved care delivery and implementation of guideline-directed medical therapy have contributed to the declining incidence of atherosclerotic cardiovascular disease in high-income countries. By contrast, the global incidence of chronic kidney disease and associated mortality is either plateaued or increased, leading to escalating direct and indirect medical costs. Given limited resources, better risk stratification approaches to identify people at risk of rapid progression to end-stage kidney disease can reduce therapeutic inertia, facilitate timely interventions and identify the need for early nephrologist referral. Among people with chronic kidney disease G3a and beyond, the kidney failure risk equations (KFRE) have been externally validated and outperformed other risk prediction models. The KFRE can also guide the timing of preparation for kidney replacement therapy with improved healthcare resources planning and may prevent multiple complications and premature mortality among people with chronic kidney disease with and without type 2 diabetes mellitus. The present review summarizes the evidence of KFRE to date and call for future research to validate and evaluate its impact on cardiovascular and mortality outcomes, as well as healthcare resource utilization in multiethnic populations and different healthcare settings.

Keyword

Albuminuria; Diabetes mellitus; Glomerular filtration rate; Kidney failure, chronic; Renal insufficiency, chronic; Risk assessment

Figure

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  Fig. 1. Predictive risk factors for diabetes-related kidney disease. eGFR, estimated glomerular filtration rate. aRapid decline in eGFR of >5 mL/min/1.73 m2 per year [16-18].

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  Fig. 2. Gaps in risk prediction and management of chronic kidney disease among people with type 2 diabetes mellitus. ESKD, end-stage kidney disease; KRT, kidney replacement therapy; GDMT, guideline-directed medical therapy; RAS, renin-angiotensin system; SGLT2, sodium-glucose co-transporter 2; nsMRA, non-steroidal mineralocorticoid receptor antagonist; GLP-1 RA, glucagon-like peptide-1 receptor agonist.

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