Chronic kidney disease in type 2 diabetes: Implications for managing glycaemic control, cardiovascular and renal risk

This review examines the current literature relating to diabetes related kidney disease (DKD) and the optimal management of cardio‐renal risk. DKD develops in approximately 40% of patients with type 2 diabetes mellitus. The mainstay of therapy is to reduce the progression of DKD by optimising hyperglycaemia, blood pressure, lipids and lifestyle. Evidence supports the role for renin‐angiotensin system blockade in limiting the progression of DKD. Recent data from diabetes related cardiovascular outcome trials and renal specific trials have provided a novel insight on the additional benefits of sodium‐glucose cotransporter‐2 inhibitors (SGLT2i) in reducing the progression of DKD as well as cardiovascular risk. Lessons have been learnt from CREDENCE and there are expectations that DAPA‐CKD and EMPA‐KIDNEY will further support the benefits of SGLT2 inhibition in relation to DKD. As a consequence, international guidelines have been updated to reflect the positive benefits. In addition, novel steroidal mineralocorticoid receptor antagonists offer a potential role in future years. The review examines the current evidence and future approach to optimising outcomes for renal protection in patients with diabetes.

• Publication year

  2020

• Venue

  Diabetes, obesity and metabolism

• Publication date

  2020-04-01

• Fields of study

  Medicine

• Identifiers
  DOI 10.1111/dom.13942PMID 32267078
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Dulaglutide and renal outcomes in type 2 diabetes: an exploratory analysis of the REWIND randomised, placebo-controlled trial.

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  2019cited by this paper
• Effects of dapagliflozin on development and progression of kidney disease in patients with type 2 diabetes: an analysis from the DECLARE-TIMI 58 randomised trial.

  2019cited by this paper
• Effect of Linagliptin vs Placebo on Major Cardiovascular Events in Adults With Type 2 Diabetes and High Cardiovascular and Renal Risk: The CARMELINA Randomized Clinical Trial

  2019cited by this paper
• Microvascular and Cardiovascular Outcomes According to Renal Function in Patients Treated With Once-Weekly Exenatide: Insights From the EXSCEL Trial

  2019cited by this paper
• 2019 update to: Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

  2019cited by this paper
• Mineralocorticoid receptor antagonists and kidney diseases: pathophysiological basis.

  2019cited by this paper
• Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes

  2019cited by this paper
• Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy.

  2019influential reference
• Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

  2018cited by this paper
• Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

  2018cited by this paper
• Update on Diabetic Nephropathy: Core Curriculum 2018.

  2018cited by this paper
• The current role of renal biopsy in diabetic patients.

  2018cited by this paper
• Microvascular Complications and Foot Care : Standards of Medical Care in Diabetes d 2019

  2018cited by this paper
• 11. Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes—2019

  2018cited by this paper
• Lixisenatide and renal outcomes in patients with type 2 diabetes and acute coronary syndrome: an exploratory analysis of the ELIXA randomised, placebo-controlled trial.

  2018cited by this paper
• Effects of empagliflozin on the urinary albumin-to-creatinine ratio in patients with type 2 diabetes and established cardiovascular disease: an exploratory analysis from the EMPA-REG OUTCOME randomised, placebo-controlled trial.

  2017cited by this paper
• A randomized controlled study of finerenone versus placebo in Japanese patients with type 2 diabetes mellitus and diabetic nephropathy.

  2017cited by this paper
• Diabetic Kidney Disease: Challenges, Progress, and Possibilities.

  2017cited by this paper
• 30 YEARS OF THE MINERALOCORTICOID RECEPTOR: Mineralocorticoid receptor antagonists: 60 years of research and development

  2017cited by this paper
• Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes

  2017cited by this paper
• Glycated Albumin Versus HbA1c in the Evaluation of Glycemic Control in Patients With Diabetes and CKD

  2017cited by this paper
• Liraglutide and Renal Outcomes in Type 2 Diabetes

  2017cited by this paper
• Glomerular Hyperfiltration in Diabetes: Mechanisms, Clinical Significance, and Treatment.

  2017cited by this paper
• Improved clinical trial enrollment criterion to identify patients with diabetes at risk of end-stage renal disease.

  2017cited by this paper
• Intensified multifactorial intervention in type 2 diabetics with microalbuminuria leads to long-term renal benefits.

  2017cited by this paper
• Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes.

  2016cited by this paper
• An Age-Calibrated Definition of Chronic Kidney Disease: Rationale and Benefits.

  2016cited by this paper
• Effects of High Density Lipoprotein Raising Therapies on Cardiovascular Outcomes in Patients with Type 2 Diabetes Mellitus, with or without Renal Impairment: The Action to Control Cardiovascular Risk in Diabetes Study

  2016cited by this paper
• Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes.

  2016cited by this paper
• Standards of Medical Care in Diabetes—2016: Summary of Revisions

  2015cited by this paper
• Effect of Finerenone on Albuminuria in Patients With Diabetic Nephropathy: A Randomized Clinical Trial.

  2015cited by this paper
• Emerging Roles of the Mineralocorticoid Receptor in Pathology: Toward New Paradigms in Clinical Pharmacology

  2015cited by this paper
• Nonsteroidal antagonists of the mineralocorticoid receptor

  2015cited by this paper
• Renal outcomes in patients with type 1 diabetes and macroalbuminuria.

  2014cited by this paper
• Cardiovascular disease in patients with chronic kidney disease

  2014cited by this paper
• Diabetic nephropathy; principles of diagnosis and treatment of diabetic kidney disease

  2014cited by this paper
• Diabetic Kidney Disease: A Report From an ADA Consensus Conference

  2014cited by this paper
• Canadian Society of Nephrology commentary on the 2012 KDIGO clinical practice guideline for the management of blood pressure in CKD.

  2014cited by this paper
• Title Diabetic kidney disease : a report from an ADA Consensus Conference

  2014cited by this paper
• A new Classification of Diabetic Nephropathy 2014: a report from Joint Committee on Diabetic Nephropathy

  2014cited by this paper
• Sweet debate: fructose versus glucose in diabetic kidney disease.

  2014cited by this paper
• 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8).

  2014cited by this paper
• Diabetic kidney disease: a report from an ADA Consensus Conference.

  2014cited by this paper
• Diabetic nephropathy – complications and treatment

  2014cited by this paper
• Combined angiotensin inhibition for the treatment of diabetic nephropathy.

  2013cited by this paper
• Comments on 'KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease'.

  2013cited by this paper
• Association Between Plasma Triglycerides and High-Density Lipoprotein Cholesterol and Microvascular Kidney Disease and Retinopathy in Type 2 Diabetes Mellitus: A Global Case–Control Study in 13 Countries

  2013cited by this paper
• Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus.

  2013cited by this paper
• 2013 ESH/ESC guidelines for the management of arterial hypertension.

  2013cited by this paper
• Diabetic nephropathy: Is it time yet for routine kidney biopsy?

  2013cited by this paper
• Intensive glucose control improves kidney outcomes in patients with type 2 diabetes.

  2013cited by this paper
• Safety and tolerability of the novel non-steroidal mineralocorticoid receptor antagonist BAY 94-8862 in patients with chronic heart failure and mild or moderate chronic kidney disease: a randomized, double-blind trial

  2013cited by this paper
• VEGF and podocytes in diabetic nephropathy.

  2012cited by this paper
• KDOQI Clinical Practice Guideline for Diabetes and CKD: 2012 Update.

  2012cited by this paper
• Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.

  2012cited by this paper
• Antihypertensive agents for preventing diabetic kidney disease.

  2012cited by this paper
• Can we target tubular damage to prevent renal function decline in diabetes?

  2012cited by this paper
• Type 2 diabetes and bone fractures

  2012cited by this paper
• A decade after the KDOQI CKD guidelines: impact on the National Kidney Foundation.

  2012cited by this paper
• Increased Serum Hepcidin Levels in Subjects with the Metabolic Syndrome: A Population Study

  2012cited by this paper
• Hepcidin expression and iron parameters change in Type 2 diabetic patients.

  2011cited by this paper
• Association between glycemic control and adverse outcomes in people with diabetes mellitus and chronic kidney disease: a population-based cohort study.

  2011cited by this paper
• Olmesartan for the delay or prevention of microalbuminuria in type 2 diabetes.

  2011cited by this paper
• Glycated albumin is the preferred marker for assessing glycaemic control in advanced chronic kidney disease

  2011cited by this paper
• Pathophysiology of the diabetic kidney.

  2011cited by this paper
• National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2·7 million participants.

  2011cited by this paper
• ACTION TO CONTROL CARDIOVASCULAR RISK IN DIABETES STUDY GROUP. EFFECTS OF INTENSIVE GLUCOSE LOWERING IN TYPE 2 DIABETES

  2010cited by this paper
• Effects of a fixed combination of perindopril and indapamide in patients with type 2 diabetes and chronic kidney disease.

  2010cited by this paper
• Ability of cystatin C to detect acute changes in glomerular filtration rate provoked by hyperglycaemia in uncomplicated Type 1 diabetes

  2010cited by this paper
• Glucose control and vascular complications in veterans with type 2 diabetes.

  2009cited by this paper
• Cognitive function and risks of cardiovascular disease and hypoglycaemia in patients with type 2 diabetes: the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial

  2009cited by this paper
• Bicarbonate supplementation slows progression of CKD and improves nutritional status.

  2009cited by this paper
• Connective tissue growth factor(CCN2), a pathogenic factor in diabetic nephropathy. What does it do? How does it do it?

  2009cited by this paper
• ORIGINAL INVESTIGATIONS Pathogenesis and Treatment of Kidney Disease Effects of Atorvastatin on Kidney Outcomes and Cardiovascular Disease in Patients With Diabetes: An Analysis From the Collaborative Atorvastatin Diabetes Study (CARDS)

  2009cited by this paper
• Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes.

  2008cited by this paper
• Microvascular disease: what does the UKPDS tell us about diabetic nephropathy?

  2008cited by this paper
• 10-year follow-up of intensive glucose control in type 2 diabetes.

  2008cited by this paper
• Effects of intensive glucose lowering in type 2 diabetes.

  2008cited by this paper
• 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)

  2007cited by this paper
• 2013 ESH/ESC Guidelines for the management of arterial hypertension

  2007cited by this paper
• 2007 ESH-ESC Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

  2007cited by this paper
• Obesity and risk for chronic renal failure.

  2006cited by this paper
• Risk Factors for Renal Dysfunction in Type 2 Diabetes

  2006cited by this paper
• Increasing incidence of proteinuria and declining incidence of end-stage renal disease in diabetic Pima Indians.

  2006cited by this paper
• Simvastatin maintains steady patterns of GFR and improves AER and expression of slit diaphragm proteins in type II diabetes.

  2006cited by this paper
• Anaemia in diabetes: is there a rationale to TREAT?

  2006influential reference
• Body Mass Index and Risk for End-Stage Renal Disease

  2006cited by this paper
• Selective aldosterone blockade with eplerenone reduces albuminuria in patients with type 2 diabetes.

  2006cited by this paper
• Beneficial effects of adding spironolactone to recommended antihypertensive treatment in diabetic nephropathy: a randomized, double-masked, cross-over study.

  2005influential reference
• Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes.

  2005cited by this paper
• Independent and additive impact of blood pressure control and angiotensin II receptor blockade on renal outcomes in the irbesartan diabetic nephropathy trial: clinical implications and limitations.

  2005cited by this paper
• Beneficial impact of spironolactone in diabetic nephropathy.

  2005influential reference
• Preventing microalbuminuria in type 2 diabetes.

  2004cited by this paper
• Remission to normoalbuminuria during multifactorial treatment preserves kidney function in patients with type 2 diabetes and microalbuminuria.

  2004cited by this paper
• Literature abstracts

  2004cited by this paper
• Angiotensin-receptor blockade versus converting-enzyme inhibition in type 2 diabetes and nephropathy.

  2004cited by this paper
• Captopril reduces the risk of nephropathy in IDDM patients with microalbuminuria

  2004cited by this paper
• Dual blockade of the renin-angiotensin system versus maximal recommended dose of ACE inhibition in diabetic nephropathy.

  2003cited by this paper
• Effects of blood pressure level on progression of diabetic nephropathy: results from the RENAAL study.

  2003cited by this paper

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  2026cites this paper
• Dysregulation of Extracellular Matrix in Diabetic Complications: Clinical Impacts and New Molecular Targets

  2025cites this paper
• Beyond Traditional Silos: An Integrated Framework Leveraging Novel Pathways for Reducing Cardio-renal Risk in Type 2 Diabetes.

  2025cites this paper
• Ginsenoside Rg2 Alleviates HFD/STZ-Induced Diabetic Nephropathy by Inhibiting Pyroptosis via NF-κB/NLRP3 Signaling Pathways.

  2025cites this paper
• Growth differentiation factor-15: A marker for diabetic kidney disease in patients with metabolic-associated fatty liver disease.

  2025cites this paper
• Predicting Type 2 diabetes onset age using machine learning: A case study in KSA

  2025cites this paper
• Integrated metabolomics and network pharmacology analysis of Yulan Jiangtang capsules in diabetic nephropathy.

  2025cites this paper
• Benefits of using SLGT2 Inhibitors for Patients with CDK and DM2 to Reduce Mortality Risks

  2024cites this paper
• Diagnostic Accuracy of Serum Cystatin C for Early Detection of Kidney Damage in Patients with Type II Diabetes Mellitus: Bahawalpur, Pakistan

  2024cites this paper
• Advances in Traditional Chinese Medicine research in diabetic kidney disease treatment

  2024cites this paper
• High Prevalence of Unrecorded Stage 3 Chronic Kidney Disease in Australia, Brazil, Canada, England, and Spain: The Multinational, Observational REVEAL‐CKD Study

  2024cites this paper
• Associations between non-insulin-based insulin resistance indices and diabetic nephropathy in patients with diabetes mellitus in US adults: a cross-sectional study of NHANES 1999–2018

  2024cites this paper
• Assessing the relationship between multimorbidity, psychosocial variables, and clinical outcomes among older adults living in rural Appalachia

  2024cites this paper
• Unveiling the utility of artificial intelligence for prediction, diagnosis, and progression of diabetic kidney disease: an evidence-based systematic review and meta-analysis

  2024cites this paper
• Relationship between serum level of miR-338-3p and miR-105-3p and bone metabolic markers in patients with diabetes nephropathy

  2024cites this paper
• Prevalence and characteristics of chronic kidney disease in people with type 2 diabetes mellitus in the Autonomous Community of Aragon.

  2024cites this paper
• Chinese botanical drugs targeting mitophagy to alleviate diabetic kidney disease, a comprehensive review

  2024cites this paper
• The Bidirectional Link Between Diabetes and Kidney Disease: Mechanisms and Management

  2023influential citation
• Association between neutrophil/lymphocyte ratio and kidney impairment in type 2 diabetes mellitus: a role of extracellular water/total body water ratio.

  2023cites this paper
• Platycodin D inhibits HFD/STZ-induced diabetic nephropathy via inflammatory and apoptotic signaling pathways in C57BL/6 mice.

  2023cites this paper
• Diagnosis coding of Chronic Kidney Disease in Type 2 Diabetes in UK primary care

  2023cites this paper
• γ-glutamylcysteine alleviates insulin resistance and hepatic steatosis by regulating adenylate cyclase and IGF-1R/IRS1/PI3K/Akt signaling pathways.

  2023cites this paper
• Diagnosis codes underestimate chronic kidney disease incidence compared with eGFR-based evidence: a retrospective observational study of patients with type 2 diabetes in UK primary care

  2023cites this paper
• Dietary acid load and risk of type 2 diabetes mellitus: A case-control study.

  2022cites this paper
• The Effects of Resistant Starch on Biomarkers of Inflammation and Oxidative Stress: A Systematic Review and Meta-Analysis

  2022cites this paper
• Management of hypertension and renin-angiotensin-aldosterone system blockade in adults with diabetic kidney disease: Association of British Clinical Diabetologists and the Renal Association UK guideline update 2021

  2022cites this paper
• Interleukin 6 in diabetes, chronic kidney disease, and cardiovascular disease: mechanisms and therapeutic perspectives

  2022cites this paper
• Nephroprotective Plants: A Review on the Use in Pre-Renal and Post-Renal Diseases

  2022influential citation
• "Multiomics" Analyses Combined with Systems Pharmacology Reveal the Renoprotection of Mangiferin Monosodium Salt in Rats with Diabetic Nephropathy: Focus on Improvements in Renal Ferroptosis, Renal Inflammation, and Podocyte Insulin Resistance.

  2022cites this paper
• Challenges in the Prevention and Management of Diabetic Kidney Diseases

  2021cites this paper
• PAR2-Induced Tissue Factor Synthesis by Primary Cultures of Human Kidney Tubular Epithelial Cells Is Modified by Glucose Availability

  2021cites this paper
• Risk of diabetic macular oedema with sodium‐glucose cotransporter‐2 inhibitors in type 2 diabetes patients: A multi‐institutional cohort study in Taiwan

  2021cites this paper
• The risk trajectory of different cardiovascular morbidities associated with chronic kidney disease among patients with newly diagnosed diabetes mellitus: a propensity score-matched cohort analysis

  2021cites this paper
• Quantification of serum C-mannosyl tryptophan by novel assay to evaluate renal function and vascular complications in patients with type 2 diabetes

  2021cites this paper
• Doxepin Exacerbates Renal Damage, Glucose Intolerance, Nonalcoholic Fatty Liver Disease, and Urinary Chromium Loss in Obese Mice

  2021influential citation
• The Role of Inhibitors SGLT2 in Diabetic Nephropathy; Literature Review

  2021cites this paper
• Hypolipidemic and Antioxidant Effects of Guishe Extract from Agave lechuguilla, a Mexican Plant with Biotechnological Potential, on Streptozotocin-Induced Diabetic Male Rats

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• Multimodal Care for Diabetes Combining Pharmacotherapy and Metabolic Surgery

  2021cites this paper
• Protective effects of Huang-Lian-Jie-Du Decoction on diabetic nephropathy through regulating AGEs/RAGE/Akt/Nrf2 pathway and metabolic profiling in db/db mice.

  2021cites this paper
• Mechanism of tangshen formula in treating diabetic nephropathy revealed by network pharmacology approach

  2021cites this paper
• Tackling type 2 diabetes-associated cardiovascular and renal comorbidities: a key challenge for drug development

  2020cites this paper
• Glucagon in type 1 diabetes patients receiving SGLT2 inhibitors: A Friend or Foe?

  2020cites this paper
• Comparative study on the efficacy of peritoneal dialysis and hemodialysis in patients with end-stage diabetic nephropathy

  2020cites this paper
• Hypothalamus-pituitary-adrenal Axis in Glucolipid metabolic disorders

  2020cites this paper
• Changes in hematological parameters during first days of diabetic ketoacidosis treatment in children with type 1 diabetes mellitus

  2020cites this paper
• Diabetic kidney disease — state-of-the-art knowledge in 2020

  2020cites this paper