Skip to main content

02-19-2018 | Nephropathy | Review | Article

The Landscape of Diabetic Kidney Disease in the United States

Journal: Current Diabetes Reports

Authors: O. Kenrik Duru, Tim Middleton, Mona K. Tewari, Keith Norris

Publisher: Springer US


Purpose of Review

The purposes of this review are to identify population characteristics of important risk factors for the development and progression of diabetic kidney disease (DKD) in the United States and to discuss barriers and opportunities to improve awareness, management, and outcomes in patients with DKD.

Recent Findings

The major risk factors for the development and progression of DKD include hyperglycemia, hypertension, and albuminuria. DKD disproportionately affects minorities and individuals with low educational and socioeconomic status. Barriers to effective management of DKD include the following: (a) limited patient and healthcare provider awareness of DKD, (b) lack of timely referrals of patients to a nephrologist, (c) low patient healthcare literacy, and (d) insufficient access to healthcare and health insurance.


Increased patient and physician awareness of DKD has been shown to enhance patient outcomes. Multifactorial and multidisciplinary interventions targeting multiple risk factors and patient/physician education may provide better outcomes in patients with DKD.
• United States Renal Data System. USRDS annual data report: epidemiology of kidney disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2017. 2017 [cited 2017 December 7]. Available from: https://​www.​usrds.​org/​adr.​aspx. Provides up-to-date data on the prevalence and awareness of CKD and ESKD in the United States.
Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, et al. Chronic kidney disease: global dimension and perspectives. Lancet. 2013;382(9888):260–72. https://​doi.​org/​10.​1016/​S0140-6736(13)60687-X.PubMedCrossRef
Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2014. 2014 [cited 2016 December 7]. Available from: http://​www.​cdc.​gov/​diabetes/​pdfs/​data/​2014-report-estimates-of-diabetes-and-its-burden-in-the-united-states.​pdf.
Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and trends in diabetes among adults in the United States, 1988–2012. JAMA. 2015;314(10):1021–9. https://​doi.​org/​10.​1001/​jama.​2015.​10029.PubMedCrossRef
• Zelnick LR, Weiss NS, Kestenbaum BR, Robinson-Cohen C, Heagerty PJ, Tuttle K, et al. Diabetes and CKD in the United States population, 2009–2014. Clin J Am Soc Nephrol. 2017. New prevalence data for DKD.
National Kidney Foundation. KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease. Am J Kidney Dis. 2007;49(suppl 2):s1–s180.
Tuttle KR, Bakris GL, Bilous RW, Chiang JL, de Boer IH, Goldstein-Fuchs J, et al. Diabetic kidney disease: a report from an ADA consensus conference. Am J Kidney Dis. 2014;64(4):510–33. https://​doi.​org/​10.​1053/​j.​ajkd.​2014.​08.​001.PubMedCrossRef
American Diabetes Association. 10. Microvascular complications and foot care. Diabetes Care. 2017;40(Suppl 1):S88–98. https://​doi.​org/​10.​2337/​dc17-S013.CrossRef
Rowley WR, Bezold C, Arikan Y, Byrne E, Krohe S. Diabetes 2030: insights from yesterday, today, and future trends. Popul Health Manag. 2017;20(1):6–12. https://​doi.​org/​10.​1089/​pop.​2015.​0181.PubMedPubMedCentralCrossRef
Delanaye P, Glassock RJ, Pottel H, Rule AD. An age-calibrated definition of chronic kidney disease: rationale and benefits. Clin Biochem Rev. 2016;37(1):17–26.PubMedPubMedCentral
Winearls CG, Glassock RJ. Classification of chronic kidney disease in the elderly: pitfalls and errors. Nephron Clin Pract. 2011;119(Suppl 1):c2–4. https://​doi.​org/​10.​1159/​000328013.PubMedCrossRef
Szczech LA, Stewart RC, Su HL, DeLoskey RJ, Astor BC, Fox CH, et al. Primary care detection of chronic kidney disease in adults with type-2 diabetes: the ADD-CKD study (awareness, detection and drug therapy in type 2 diabetes and chronic kidney disease). PLoS One. 2014;9(11):e110535. https://​doi.​org/​10.​1371/​journal.​pone.​0110535.PubMedPubMedCentralCrossRef
Berhane AM, Weil EJ, Knowler WC, Nelson RG, Hanson RL. Albuminuria and estimated glomerular filtration rate as predictors of diabetic end-stage renal disease and death. Clin J Am Soc Nephrol. 2011;6(10):2444–51. https://​doi.​org/​10.​2215/​CJN.​00580111.PubMedPubMedCentralCrossRef
Turin TC, Ahmed SB, Tonelli M, Manns B, Ravani P, James M, et al. Kidney function, albuminuria and life expectancy. Can J Kidney Health Dis. 2014;1:33. https://​doi.​org/​10.​1186/​s40697-014-0033-6.PubMedPubMedCentralCrossRef
MacIsaac RJ, Tsalamandris C, Panagiotopoulos S, Smith TJ, McNeil KJ, Jerums G. Nonalbuminuric renal insufficiency in type 2 diabetes. Diabetes Care. 2004;27(1):195–200. https://​doi.​org/​10.​2337/​diacare.​27.​1.​195.PubMedCrossRef
Molitch ME, Steffes M, Sun W, Rutledge B, Cleary P, de Boer IH, et al. Development and progression of renal insufficiency with and without albuminuria in adults with type 1 diabetes in the diabetes control and complications trial and the epidemiology of diabetes interventions and complications study. Diabetes Care. 2010;33(7):1536–43. https://​doi.​org/​10.​2337/​dc09-1098.PubMedPubMedCentralCrossRef
MacIsaac RJ, Ekinci EI, Jerums G. Progressive diabetic nephropathy. How useful is microalbuminuria?: contra. Kidney Int. 2014;86(1):50–7. https://​doi.​org/​10.​1038/​ki.​2014.​98.PubMedCrossRef
Emerging Risk Factors Collaboration, Seshasai SR, Kaptoge S, Thompson A, Di Angelantonio E, Gao P, et al. Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med. 2011;364(9):829–41. https://​doi.​org/​10.​1056/​NEJMoa1008862.CrossRef
Rossing K, Christensen PK, Hovind P, Tarnow L, Rossing P, Parving HH. Progression of nephropathy in type 2 diabetic patients. Kidney Int. 2004;66(4):1596–605. https://​doi.​org/​10.​1111/​j.​1523-1755.​2004.​00925.​x.PubMedCrossRef
Keith DS, Nichols GA, Gullion CM, Brown JB, Smith DH. Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med. 2004;164(6):659–63. https://​doi.​org/​10.​1001/​archinte.​164.​6.​659.PubMedCrossRef
Leehey DJ, Kramer HJ, Daoud TM, Chatha MP, Isreb MA. Progression of kidney disease in type 2 diabetes—beyond blood pressure control: an observational study. BMC Nephrol. 2005;6(1):8. https://​doi.​org/​10.​1186/​1471-2369-6-8.PubMedPubMedCentralCrossRef
Robinson-Cohen C, Littman AJ, Duncan GE, Weiss NS, Sachs MC, Ruzinski J, et al. Physical activity and change in estimated GFR among persons with CKD. J Am Soc Nephrol. 2014;25(2):399–406. https://​doi.​org/​10.​1681/​ASN.​2013040392.PubMedCrossRef
Adler AI, Stevens RJ, Manley SE, Bilous RW, Cull CA, Holman RR, et al. Development and progression of nephropathy in type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney Int. 2003;63(1):225–32. https://​doi.​org/​10.​1046/​j.​1523-1755.​2003.​00712.​x.PubMedCrossRef
Di Angelantonio E, Chowdhury R, Sarwar N, Aspelund T, Danesh J, Gudnason V. Chronic kidney disease and risk of major cardiovascular disease and non-vascular mortality: prospective population based cohort study. BMJ. 2010;341(sep30 1):c4986. https://​doi.​org/​10.​1136/​bmj.​c4986.PubMedPubMedCentralCrossRef
van der Velde M, Matsushita K, Coresh J, Astor BC, Woodward M, Levey A, et al. Lower estimated glomerular filtration rate and higher albuminuria are associated with all-cause and cardiovascular mortality. A collaborative meta-analysis of high-risk population cohorts. Kidney Int. 2011;79(12):1341–52. https://​doi.​org/​10.​1038/​ki.​2010.​536.PubMedCrossRef
Ninomiya T, Perkovic V, de Galan BE, Zoungas S, Pillai A, Jardine M, et al. Albuminuria and kidney function independently predict cardiovascular and renal outcomes in diabetes. J Am Soc Nephrol. 2009;20(8):1813–21. https://​doi.​org/​10.​1681/​ASN.​2008121270.PubMedPubMedCentralCrossRef
Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA. 2014;311(8):806–14. https://​doi.​org/​10.​1001/​jama.​2014.​732.PubMedPubMedCentralCrossRef
Aguilar M, Bhuket T, Torres S, Liu B, Wong RJ. Prevalence of the metabolic syndrome in the United States, 2003–2012. JAMA. 2015;313(19):1973–4. https://​doi.​org/​10.​1001/​jama.​2015.​4260.PubMedCrossRef
Retnakaran R, Cull CA, Thorne KI, Adler AI, Holman RR, Group US. Risk factors for renal dysfunction in type 2 diabetes: U.K. prospective diabetes study 74. Diabetes. 2006;55(6):1832–9. https://​doi.​org/​10.​2337/​db05-1620.PubMedCrossRef
Ali MK, Bullard KM, Saaddine JB, Cowie CC, Imperatore G, Gregg EW. Achievement of goals in U.S. diabetes care, 1999–2010. N Engl J Med. 2013;368(17):1613–24. https://​doi.​org/​10.​1056/​NEJMsa1213829.PubMedCrossRef
Stark Casagrande S, Fradkin JE, Saydah SH, Rust KF, Cowie CC. The prevalence of meeting A1C, blood pressure, and LDL goals among people with diabetes, 1988–2010. Diabetes Care. 2013;36(8):2271–9. https://​doi.​org/​10.​2337/​dc12-2258.PubMedPubMedCentralCrossRef
Diabetes Control Complications Trial Research Group, Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977–86.CrossRef
Nathan DM, Cleary PA, Backlund JY, Genuth SM, Lachin JM, Orchard TJ, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005;353(25):2643–53. https://​doi.​org/​10.​1056/​NEJMoa052187.PubMedCrossRef
Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, Byington RP, Goff DC Jr, Bigger JT, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358(24):2545–59.CrossRef
Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven PD, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360(2):129–39. https://​doi.​org/​10.​1056/​NEJMoa0808431.PubMedCrossRef
Advance Collaborative Group, Patel A, MacMahon S, Chalmers J, Neal B, Billot L, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358(24):2560–72.CrossRef
Bonds DE, Miller ME, Bergenstal RM, Buse JB, Byington RP, Cutler JA, et al. The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes: retrospective epidemiological analysis of the ACCORD study. BMJ. 2010;340(jan08 1):b4909. https://​doi.​org/​10.​1136/​bmj.​b4909.PubMedPubMedCentralCrossRef
National Kidney Foundation. KDOQI clinical practice guideline for diabetes and CKD: 2012 update. Am J Kidney Dis. 2012;60(5):850–86.CrossRef
Begun A, Icks A, Waldeyer R, Landwehr S, Koch M, Giani G. Identification of a multistate continuous-time nonhomogeneous Markov chain model for patients with decreased renal function. Med Decis Mak. 2013;33(2):298–306. https://​doi.​org/​10.​1177/​0272989X12466731​.CrossRef
Hodge M, McArthur E, Garg AX, Tangri N, Clemens KK. Hypoglycemia incidence in older adults by estimated GFR. Am J Kidney Dis. 2017;70(1):59–68. https://​doi.​org/​10.​1053/​j.​ajkd.​2016.​11.​019.PubMedCrossRef
• de Boer IH, Bangalore S, Benetos A, Davis AM, Michos ED, Muntner P, et al. Diabetes and hypertension: a position statement by the American Diabetes Association. Diabetes Care. 2017;40(9):1273–84. https://​doi.​org/​10.​2337/​dci17-0026. Current recommendations for blood pressure control in diabetes.
• Whelton PK, Carey RM, Aronow WS, Casey DE, Jr., Collins KJ, Dennison Himmelfarb C, et al. ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017. Current recommendations for blood pressure control in diabetes.
Krauss RM. Lipids and lipoproteins in patients with type 2 diabetes. Diabetes Care. 2004;27(6):1496–504. https://​doi.​org/​10.​2337/​diacare.​27.​6.​1496.PubMedCrossRef
KDIGO. Clinical practice guidelines for lipid management in chronic kidney disease. Kidney Int Suppl. 2013;3(3):271–9.CrossRef
Astor BC, Matsushita K, Gansevoort RT, van der Velde M, Woodward M, Levey AS, et al. Lower estimated glomerular filtration rate and higher albuminuria are associated with mortality and end-stage renal disease. A collaborative meta-analysis of kidney disease population cohorts. Kidney Int. 2011;79(12):1331–40. https://​doi.​org/​10.​1038/​ki.​2010.​550.PubMedCrossRef
Amin AP, Whaley-Connell AT, Li S, Chen SC, McCullough PA, Kosiborod MN, et al. The synergistic relationship between estimated GFR and microalbuminuria in predicting long-term progression to ESRD or death in patients with diabetes: results from the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis. 2013;61(4 Suppl 2):S12–23. https://​doi.​org/​10.​1053/​j.​ajkd.​2013.​01.​005.PubMedPubMedCentralCrossRef
Bakris GL, Molitch M. Microalbuminuria as a risk predictor in diabetes: the continuing saga. Diabetes Care. 2014;37(3):867–75. https://​doi.​org/​10.​2337/​dc13-1870.PubMedCrossRef
Roscioni SS, Lambers Heerspink HJ, de Zeeuw D. Microalbuminuria: target for renoprotective therapy PRO. Kidney Int. 2014;86(1):40–9. https://​doi.​org/​10.​1038/​ki.​2013.​490.PubMedCrossRef
Lopez-Novoa JM, Rodriguez-Pena AB, Ortiz A, Martinez-Salgado C, Lopez Hernandez FJ. Etiopathology of chronic tubular, glomerular and renovascular nephropathies: clinical implications. J Transl Med. 2011;9(1):13. https://​doi.​org/​10.​1186/​1479-5876-9-13.PubMedPubMedCentralCrossRef
Langsford D, Tang M, Cheikh Hassan HI, Djurdjev O, Sood MM, Levin A. The association between biomarker profiles, etiology of chronic kidney disease, and mortality. Am J Nephrol. 2017;45(3):226–34. https://​doi.​org/​10.​1159/​000454991.PubMedCrossRef
Sun J, Axelsson J, Machowska A, Heimburger O, Barany P, Lindholm B, et al. Biomarkers of cardiovascular disease and mortality risk in patients with advanced CKD. Clin J Am Soc Nephrol. 2016;11(7):1163–72. https://​doi.​org/​10.​2215/​CJN.​10441015.PubMedPubMedCentralCrossRef
Inker LA, Levey AS, Pandya K, Stoycheff N, Okparavero A, Greene T, et al. Early change in proteinuria as a surrogate end point for kidney disease progression: an individual patient meta-analysis. Am J Kidney Dis. 2014;64(1):74–85. https://​doi.​org/​10.​1053/​j.​ajkd.​2014.​02.​020.PubMedPubMedCentralCrossRef
Nicholas SB, Kalantar-Zadeh K, Norris KC. Racial disparities in kidney disease outcomes. Semin Nephrol. 2013;33(5):409–15. https://​doi.​org/​10.​1016/​j.​semnephrol.​2013.​07.​002.PubMedPubMedCentralCrossRef
Nicholas SB, Kalantar-Zadeh K, Norris KC. Socioeconomic disparities in chronic kidney disease. Adv Chronic Kidney Dis. 2015;22(1):6–15. https://​doi.​org/​10.​1053/​j.​ackd.​2014.​07.​002.PubMedPubMedCentralCrossRef
Kurella Tamura M, Anand S, Li S, Chen SC, Whaley-Connell AT, Stevens LA, et al. Comparison of CKD awareness in a screening population using the Modification of Diet in Renal Disease (MDRD) study and CKD Epidemiology Collaboration (CKD-EPI) equations. Am J Kidney Dis. 2011;57(3 Suppl 2):S17–23. https://​doi.​org/​10.​1053/​j.​ajkd.​2010.​11.​008.PubMedCrossRef
• Ene-Iordache B, Perico N, Bikbov B, Carminati S, Remuzzi A, Perna A, et al. Chronic kidney disease and cardiovascular risk in six regions of the world (ISN-KDDC): a cross-sectional study. Lancet Glob Health. 2016;4(5):e307–19. https://​doi.​org/​10.​1016/​S2214-109X(16)00071-1. Provides a global perspective on CKD.PubMedCrossRef
Plantinga LC, Boulware LE, Coresh J, Stevens LA, Miller ER 3rd, Saran R, et al. Patient awareness of chronic kidney disease: trends and predictors. Arch Intern Med. 2008;168(20):2268–75. https://​doi.​org/​10.​1001/​archinte.​168.​20.​2268.PubMedPubMedCentralCrossRef
Whaley-Connell A, Bomback AS, McFarlane SI, Li S, Roberts T, Chen SC, et al. Diabetic cardiovascular disease predicts chronic kidney disease awareness in the Kidney Early Evaluation Program. Cardiorenal Med. 2011;1(1):45–52. https://​doi.​org/​10.​1159/​000322862.PubMedPubMedCentralCrossRef
Guessous I, McClellan W, Vupputuri S, Wasse H. Low documentation of chronic kidney disease among high-risk patients in a managed care population: a retrospective cohort study. BMC Nephrol. 2009;10(1):25. https://​doi.​org/​10.​1186/​1471-2369-10-25.PubMedPubMedCentralCrossRef
Tuot DS, Plantinga LC, Hsu CY, Jordan R, Burrows NR, Hedgeman E, et al. Chronic kidney disease awareness among individuals with clinical markers of kidney dysfunction. Clin J Am Soc Nephrol. 2011;6(8):1838–44. https://​doi.​org/​10.​2215/​CJN.​00730111.PubMedPubMedCentralCrossRef
Bruce MA, Beech BM, Crook ED, Sims M, Wyatt SB, Flessner MF, et al. Association of socioeconomic status and CKD among African Americans: the Jackson Heart Study. Am J Kidney Dis. 2010;55(6):1001–8. https://​doi.​org/​10.​1053/​j.​ajkd.​2010.​01.​016.PubMedPubMedCentralCrossRef
Choi AI, Weekley CC, Chen SC, Li S, Tamura MK, Norris KC, et al. Association of educational attainment with chronic disease and mortality: the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis. 2011;58(2):228–34. https://​doi.​org/​10.​1053/​j.​ajkd.​2011.​02.​388.PubMedPubMedCentralCrossRef
Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97–107. https://​doi.​org/​10.​7326/​0003-4819-155-2-201107190-00005.PubMedCrossRef
Hall YN, Rodriguez RA, Boyko EJ, Chertow GM, O'Hare AM. Characteristics of uninsured Americans with chronic kidney disease. J Gen Intern Med. 2009;24(8):917–22. https://​doi.​org/​10.​1007/​s11606-009-1028-3.PubMedPubMedCentralCrossRef
Agrawal V, Jaar BG, Frisby XY, Chen SC, Qiu Y, Li S, et al. Access to health care among adults evaluated for CKD: findings from the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis. 2012;59(3 Suppl 2):S5–15. https://​doi.​org/​10.​1053/​j.​ajkd.​2011.​10.​043.PubMedPubMedCentralCrossRef
Hughes-Carter DL, Hoebeke RE. Screening for diabetic kidney disease in primary care for the underinsured: a quality improvement initiative. Appl Nurs Res. 2016;30:148–53. https://​doi.​org/​10.​1016/​j.​apnr.​2015.​11.​008.PubMedCrossRef
Boulware LE, Troll MU, Jaar BG, Myers DI, Powe NR. Identification and referral of patients with progressive CKD: a national study. Am J Kidney Dis. 2006;48(2):192–204. https://​doi.​org/​10.​1053/​j.​ajkd.​2006.​04.​073.PubMedCrossRef
Lea JP, McClellan WM, Melcher C, Gladstone E, Hostetter T. CKD risk factors reported by primary care physicians: do guidelines make a difference? Am J Kidney Dis. 2006;47(1):72–7. https://​doi.​org/​10.​1053/​j.​ajkd.​2005.​09.​027.PubMedCrossRef
Stuckey HL, Vallis M, Kovacs Burns K, Mullan-Jensen CB, Reading JM, Kalra S, et al. “I do my best to listen to patients”: qualitative insights into DAWN2 (Diabetes psychosocial care from the perspective of health care professionals in the second Diabetes Attitudes, Wishes and Needs Study). Clin Ther. 2015;37(9):1986–98 e12. https://​doi.​org/​10.​1016/​j.​clinthera.​2015.​06.​010.PubMedCrossRef
Sinsky C, Colligan L, Li L, Prgomet M, Reynolds S, Goeders L, et al. Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Ann Intern Med. 2016;165(11):753–60. https://​doi.​org/​10.​7326/​M16-0961.PubMedCrossRef
Martinez-Ramirez HR, Jalomo-Martinez B, Cortes-Sanabria L, Rojas-Campos E, Barragan G, Alfaro G, et al. Renal function preservation in type 2 diabetes mellitus patients with early nephropathy: a comparative prospective cohort study between primary health care doctors and a nephrologist. Am J Kidney Dis. 2006;47(1):78–87. https://​doi.​org/​10.​1053/​j.​ajkd.​2005.​09.​015.PubMedCrossRef
Jones C, Roderick P, Harris S, Rogerson M. Decline in kidney function before and after nephrology referral and the effect on survival in moderate to advanced chronic kidney disease. Nephrol Dial Transplant. 2006;21(8):2133–43. https://​doi.​org/​10.​1093/​ndt/​gfl198.PubMedCrossRef
Winkelmayer WC, Owen WF Jr, Levin R, Avorn J. A propensity analysis of late versus early nephrologist referral and mortality on dialysis. J Am Soc Nephrol. 2003;14(2):486–92. https://​doi.​org/​10.​1097/​01.​ASN.​0000046047.​66958.​C3.PubMedCrossRef
Kohan DE. Training the next generation of nephrologists. Clin J Am Soc Nephrol. 2011;6(11):2564–6. https://​doi.​org/​10.​2215/​CJN.​08940811.PubMedCrossRef
Sharif MU, Elsayed ME, Stack AG. The global nephrology workforce: emerging threats and potential solutions! Clin Kidney J. 2016;9(1):11–22. https://​doi.​org/​10.​1093/​ckj/​sfv111.PubMedCrossRef
KDIGO. 2012 Clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3(1):1–150.CrossRef
Vassalotti JA, Centor R, Turner BJ, Greer RC, Choi M, Sequist TD, et al. Practical approach to detection and management of chronic kidney disease for the primary care clinician. Am J Med. 2016;129(2):153–62 e7. https://​doi.​org/​10.​1016/​j.​amjmed.​2015.​08.​025.PubMedCrossRef
Gillespie BW, Morgenstern H, Hedgeman E, Tilea A, Scholz N, Shearon T, et al. Nephrology care prior to end-stage renal disease and outcomes among new ESRD patients in the USA. Clin Kidney J. 2015;8(6):772–80. https://​doi.​org/​10.​1093/​ckj/​sfv103.PubMedPubMedCentralCrossRef
Nee R, Yuan CM, Hurst FP, Jindal RM, Agodoa LY, Abbott KC. Impact of poverty and race on pre-end-stage renal disease care among dialysis patients in the United States. Clin Kidney J. 2017;10(1):55–61. https://​doi.​org/​10.​1093/​ckj/​sfw098
Khunti K, Wolden ML, Thorsted BL, Andersen M, Davies MJ. Clinical inertia in people with type 2 diabetes: a retrospective cohort study of more than 80,000 people. Diabetes Care. 2013;36(11):3411–7. https://​doi.​org/​10.​2337/​dc13-0331.PubMedPubMedCentralCrossRef
Desai N, Madhavankutty Saraswathy V, Hunter K, McFadden C. Prevalence of true therapeutic inertia in blood pressure control in an academic chronic kidney disease clinic. J Clin Hypertens (Greenwich). 2013;15(6):375–9. https://​doi.​org/​10.​1111/​jch.​12095.CrossRef
Bailie GR, Eisele G, Liu L, Roys E, Kiser M, Finkelstein F, et al. Patterns of medication use in the RRI-CKD study: focus on medications with cardiovascular effects. Nephrol Dial Transplant. 2005;20(6):1110–5. https://​doi.​org/​10.​1093/​ndt/​gfh771.PubMedCrossRef
Muntner P, Judd SE, Krousel-Wood M, McClellan WM, Safford MM. Low medication adherence and hypertension control among adults with CKD: data from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study. Am J Kidney Dis. 2010;56(3):447–57. https://​doi.​org/​10.​1053/​j.​ajkd.​2010.​02.​348.PubMedPubMedCentralCrossRef
Lam WY, Fresco P. Medication adherence measures: an overview. Biomed Res Int. 2015;2015:217047.PubMedPubMedCentral
Narva AS, Bilous RW. Laboratory assessment of diabetic kidney disease. Diabetes Spectr. 2015;28(3):162–6. https://​doi.​org/​10.​2337/​diaspect.​28.​3.​162.PubMedPubMedCentralCrossRef
Drawz PE, Archdeacon P, McDonald CJ, Powe NR, Smith KA, Norton J, et al. CKD as a model for improving chronic disease care through electronic health records. Clin J Am Soc Nephrol. 2015;10(8):1488–99. https://​doi.​org/​10.​2215/​CJN.​00940115.PubMedPubMedCentralCrossRef
Tuot DS, Diamantidis CJ, Corbett CF, Boulware LE, Fox CH, Harwood DH, et al. The last mile: translational research to improve CKD outcomes. Clin J Am Soc Nephrol. 2014;9(10):1802–5. https://​doi.​org/​10.​2215/​CJN.​04310514.PubMedPubMedCentralCrossRef
Narva AS, Norton JM, Boulware LE. Educating patients about CKD: the path to self-management and patient-centered care. Clin J Am Soc Nephrol. 2016;11(4):694–703. https://​doi.​org/​10.​2215/​CJN.​07680715.PubMedCrossRef
Norton JM, Moxey-Mims MM, Eggers PW, Narva AS, Star RA, Kimmel PL, et al. Social determinants of racial disparities in CKD. J Am Soc Nephrol. 2016;27(9):2576–95. https://​doi.​org/​10.​1681/​ASN.​2016010027.PubMedPubMedCentral
Goldstein K, Briggs M, Oleynik V, Cullen M, Jones J, Newman E, et al. Using digital media to promote kidney disease education. Adv Chronic Kidney Dis. 2013;20(4):364–9. https://​doi.​org/​10.​1053/​j.​ackd.​2013.​04.​001.PubMedPubMedCentralCrossRef
Bear RA, Stockie S. Patient engagement and patient-centred care in the management of advanced chronic kidney disease and chronic kidney failure. Can J Kidney Health Dis. 2014;1:24. https://​doi.​org/​10.​1186/​s40697-014-0024-7.PubMedPubMedCentralCrossRef
Wright Nunes J, Greene JH, Wallston K, Eden S, Shintani A, Elasy T, et al. Pilot study of a physician-delivered education tool to increase patient knowledge about CKD. Am J Kidney Dis. 2013;62(1):23–32. https://​doi.​org/​10.​1053/​j.​ajkd.​2013.​01.​023.PubMedCrossRef
Wright-Nunes JA, Luther JM, Ikizler TA, Cavanaugh KL. Patient knowledge of blood pressure target is associated with improved blood pressure control in chronic kidney disease. Patient Educ Couns. 2012;88(2):184–8. https://​doi.​org/​10.​1016/​j.​pec.​2012.​02.​015.PubMedPubMedCentralCrossRef
Devins GM, Mendelssohn DC, Barre PE, Taub K, Binik YM. Predialysis psychoeducational intervention extends survival in CKD: a 20-year follow-up. Am J Kidney Dis. 2005;46(6):1088–98. https://​doi.​org/​10.​1053/​j.​ajkd.​2005.​08.​017.PubMedCrossRef
Devins GM, Mendelssohn DC, Barre PE, Binik YM. Predialysis psychoeducational intervention and coping styles influence time to dialysis in chronic kidney disease. Am J Kidney Dis. 2003;42(4):693–703. https://​doi.​org/​10.​1016/​S0272-6386(03)00835-7.PubMedCrossRef
Cavanaugh K, Wallston KA, Gebretsadik T, Shintani A, Huizinga MM, Davis D, et al. Addressing literacy and numeracy to improve diabetes care: two randomized controlled trials. Diabetes Care. 2009;32(12):2149–55. https://​doi.​org/​10.​2337/​dc09-0563.PubMedPubMedCentralCrossRef
Galbraith L, Hemmelgarn B, Manns B, Samuel S, Kappel J, Valk N, et al. The association between individual counselling and health behaviour change: the See Kidney Disease (SeeKD) targeted screening programme for chronic kidney disease. Can J Kidney Health Dis. 2016;3:35.PubMedPubMedCentralCrossRef
National Institutes of Health. National Kidney Disease Education Program (NKDEP). [cited 2017 February 2]. Available from: https://​www.​niddk.​nih.​gov/​health-information/​health-communication-programs/​nkdep/​Pages/​default.​aspx.
Fadem SZ. State of the art: chronic kidney disease education. Dial Transplant. 2011;40(9):397–400. https://​doi.​org/​10.​1002/​dat.​20606.CrossRef
Pagels AA, Hylander B, Alvarsson M. A multi-dimensional support programme for patients with diabetic kidney disease. J Ren Care. 2015;41(3):187–94. https://​doi.​org/​10.​1111/​jorc.​12114.PubMedCrossRef
National Kidney Foundation. [cited 2017 February 2]. Available from: https://​www.​kidney.​org/​professionals/​KLS/​cmeprograms.
Medical Education Institute. [cited 2017 February 2]. Available from: https://​meiresearch.​org.
Renal Physicians Association. [cited 2017 February 2]. Available from: http://​rpa.​mycrowdwisdom.​com/​diweb/​home.
Moyer VA, Force USPST. Screening for chronic kidney disease: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157(8):567–70. https://​doi.​org/​10.​7326/​0003-4819-157-8-201210160-00533.PubMedCrossRef
Qaseem A, Hopkins RH Jr, Sweet DE, Starkey M, Shekelle P, Clinical Guidelines Committee of the American College of Physicians. Screening, monitoring, and treatment of stage 1 to 3 chronic kidney disease: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2013;159(12):835–47. https://​doi.​org/​10.​7326/​0003-4819-159-12-201312170-00726.PubMed
American Socity of Nephrology. ASN emphasizes need for early detection of kidney disease, a silent killer. 2013 [cited 2017 May 10]. Available from: https://​www.​asn-online.​org/​news/​2013/​ASN_​COMM_​ACP_​Screening_​Response_​102213_​R12.​pdf.
Hoerger TJ, Wittenborn JS, Zhuo X, Pavkov ME, Burrows NR, Eggers P, et al. Cost-effectiveness of screening for microalbuminuria among African Americans. J Am Soc Nephrol. 2012;23(12):2035–41. https://​doi.​org/​10.​1681/​ASN.​2012040347.PubMedPubMedCentralCrossRef
Hoerger TJ, Wittenborn JS, Segel JE, Burrows NR, Imai K, Eggers P, et al. A health policy model of CKD: 2. The cost-effectiveness of microalbuminuria screening. Am J Kidney Dis. 2010;55(3):463–73. https://​doi.​org/​10.​1053/​j.​ajkd.​2009.​11.​017.PubMedCrossRef
Komenda P, Ferguson TW, Macdonald K, Rigatto C, Koolage C, Sood MM, et al. Cost-effectiveness of primary screening for CKD: a systematic review. Am J Kidney Dis. 2014;63(5):789–97. https://​doi.​org/​10.​1053/​j.​ajkd.​2013.​12.​012.PubMedCrossRef
Boulware LE, Jaar BG, Tarver-Carr ME, Brancati FL, Powe NR. Screening for proteinuria in US adults: a cost-effectiveness analysis. JAMA. 2003;290(23):3101–14. https://​doi.​org/​10.​1001/​jama.​290.​23.​3101.PubMedCrossRef
Yarnoff BO, Hoerger TJ, Simpson SK, Leib A, Burrows NR, Shrestha SS, et al. The cost-effectiveness of using chronic kidney disease risk scores to screen for early-stage chronic kidney disease. BMC Nephrol. 2017;18(1):85. https://​doi.​org/​10.​1186/​s12882-017-0497-6.PubMedPubMedCentralCrossRef
American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2017;40(suppl 1):s1–s129.
Sarafidis PA, Riehle J, Bogojevic Z, Basta E, Chugh A, Bakris GL. A comparative evaluation of various methods for microalbuminuria screening. Am J Nephrol. 2008;28(2):324–9. https://​doi.​org/​10.​1159/​000111825.PubMedCrossRef
Whaley-Connell AT, Sowers JR, Stevens LA, McFarlane SI, Shlipak MG, Norris KC, et al. CKD in the United States: Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES) 1999–2004. Am J Kidney Dis. 2008;51(4 Suppl 2):S13–20. https://​doi.​org/​10.​1053/​j.​ajkd.​2007.​12.​016.PubMedCrossRef
Bello AK, Peters J, Wight J, El Nahas M. The Kidney Evaluation and Awareness Program in Sheffield (KEAPS): a community-based screening for microalbuminuria in a British population. Nephron Clin Pract. 2010;116(2):c95–103. https://​doi.​org/​10.​1159/​000314658.PubMedCrossRef
Mathew TH, Corso O, Ludlow M, Boyle A, Cass A, Chadban SJ, et al. Screening for chronic kidney disease in Australia: a pilot study in the community and workplace. Kidney Int Suppl. 2010;116:S9–16.CrossRef
Jolly SE, Li S, Chen SC, Narva AS, Jurkovitz CT, Norris KC, et al. Risk factors for chronic kidney disease among American Indians and Alaska Natives—findings from the Kidney Early Evaluation Program. Am J Nephrol. 2009;29(5):440–6. https://​doi.​org/​10.​1159/​000174857.PubMedCrossRef
Hwang SJ, Tsai JC, Chen HC. Epidemiology, impact and preventive care of chronic kidney disease in Taiwan. Nephrology (Carlton). 2010;15(Suppl 2):3–9. https://​doi.​org/​10.​1111/​j.​1440-1797.​2010.​01304.​x.CrossRef
Satko SG, Sedor JR, Iyengar SK, Freedman BI. Familial clustering of chronic kidney disease. Semin Dial. 2007;20(3):229–36. https://​doi.​org/​10.​1111/​j.​1525-139X.​2007.​00282.​x.PubMedCrossRef
Levey AS, Inker LA, Coresh J. GFR estimation: from physiology to public health. Am J Kidney Dis. 2014;63(5):820–34. https://​doi.​org/​10.​1053/​j.​ajkd.​2013.​12.​006.PubMedPubMedCentralCrossRef
Accetta NA, Gladstone EH, DiSogra C, Wright EC, Briggs M, Narva AS. Prevalence of estimated GFR reporting among US clinical laboratories. Am J Kidney Dis. 2008;52(4):778–87. https://​doi.​org/​10.​1053/​j.​ajkd.​2008.​05.​023.PubMedPubMedCentralCrossRef
Schievink B, Kropelin T, Mulder S, Parving HH, Remuzzi G, Dwyer J, et al. Early renin-angiotensin system intervention is more beneficial than late intervention in delaying end-stage renal disease in patients with type 2 diabetes. Diabetes Obes Metab. 2016;18(1):64–71. https://​doi.​org/​10.​1111/​dom.​12583.PubMedCrossRef
Taal MW. Predicting renal risk in the general population: do we have the right formula? Clin J Am Soc Nephrol. 2011;6(7):1523–5. https://​doi.​org/​10.​2215/​CJN.​04200511.PubMedCrossRef
Echouffo-Tcheugui JB, Kengne AP. Risk models to predict chronic kidney disease and its progression: a systematic review. PLoS Med. 2012;9(11):e1001344. https://​doi.​org/​10.​1371/​journal.​pmed.​1001344.PubMedPubMedCentralCrossRef
Dunkler D, Gao P, Lee SF, Heinze G, Clase CM, Tobe S, et al. Risk prediction for early CKD in type 2 diabetes. Clin J Am Soc Nephrol. 2015;10(8):1371–9. https://​doi.​org/​10.​2215/​CJN.​10321014.PubMedPubMedCentralCrossRef
Halbesma N, Jansen DF, Heymans MW, Stolk RP, de Jong PE, Gansevoort RT, et al. Development and validation of a general population renal risk score. Clin J Am Soc Nephrol. 2011;6(7):1731–8. https://​doi.​org/​10.​2215/​CJN.​08590910.PubMedCrossRef
Perotte A, Ranganath R, Hirsch JS, Blei D, Elhadad N. Risk prediction for chronic kidney disease progression using heterogeneous electronic health record data and time series analysis. J Am Med Inform Assoc. 2015;22(4):872–80. https://​doi.​org/​10.​1093/​jamia/​ocv024.PubMedPubMedCentralCrossRef
Schutte E, Gansevoort RT, Benner J, Lutgers HL, Lambers Heerspink HJ. Will the future lie in multitude? A critical appraisal of biomarker panel studies on prediction of diabetic kidney disease progression. Nephrol Dial Transplant. 2015;30(Suppl 4):iv96–104. https://​doi.​org/​10.​1093/​ndt/​gfv119.PubMedCrossRef
Tangri N, Stevens LA, Griffith J, Tighiouart H, Djurdjev O, Naimark D, et al. A predictive model for progression of chronic kidney disease to kidney failure. JAMA. 2011;305(15):1553–9. https://​doi.​org/​10.​1001/​jama.​2011.​451.PubMedCrossRef
Johns TS, Yee J, Smith-Jules T, Campbell RC, Bauer C. Interdisciplinary care clinics in chronic kidney disease. BMC Nephrol. 2015;16(1):161. https://​doi.​org/​10.​1186/​s12882-015-0158-6.PubMedPubMedCentralCrossRef
Bayliss EA, Bhardwaja B, Ross C, Beck A, Lanese DM. Multidisciplinary team care may slow the rate of decline in renal function. Clin J Am Soc Nephrol. 2011;6(4):704–10. https://​doi.​org/​10.​2215/​CJN.​06610810.PubMedPubMedCentralCrossRef
Chen PM, Lai TS, Chen PY, Lai CF, Yang SY, Wu V, et al. Multidisciplinary care program for advanced chronic kidney disease: reduces renal replacement and medical costs. Am J Med. 2015;128(1):68–76. https://​doi.​org/​10.​1016/​j.​amjmed.​2014.​07.​042.PubMedCrossRef
McKenzie AL, Hallberg SJ, Creighton BC, Volk BM, Link TM, Abner MK, et al. A novel intervention including individualized nutritional recommendations reduces hemoglobin a1c level, medication use, and weight in type 2 diabetes. JMIR Diabetes. 2017;2(1):e5. https://​doi.​org/​10.​2196/​diabetes.​6981.CrossRef
Chen F, Su W, Becker SH, Payne M, Castro Sweet CM, Peters AL, et al. Clinical and economic impact of a digital, remotely-delivered intensive behavioral counseling program on Medicare beneficiaries at risk for diabetes and cardiovascular disease. PLoS One. 2016;11(10):e0163627. https://​doi.​org/​10.​1371/​journal.​pone.​0163627.PubMedPubMedCentralCrossRef
•• Molitch ME, Adler AI, Flyvbjerg A, Nelson RG, So WY, Wanner C, et al. Diabetic kidney disease: a clinical update from Kidney Disease: Improving Global Outcomes. Kidney Int. 2015;87(1):20–30. https://​doi.​org/​10.​1038/​ki.​2014.​128. Discusses a number of areas in the management of DKD.PubMedCrossRef
Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003;348(5):383–93. https://​doi.​org/​10.​1056/​NEJMoa021778.PubMedCrossRef
•• Oellgaard J, Gaede P, Rossing P, Persson F, Parving HH, Pedersen O. Intensified multifactorial intervention in type 2 diabetics with microalbuminuria leads to long-term renal benefits. Kidney Int. 2017. Discusses the impact of intensified, multifactorial treatment on renal outcomes in patients with DKD.
Crowley ST, Belcher J, Choudhury D, Griffin C, Pichler R, Robey B, et al. Targeting access to kidney care via telehealth: the VA experience. Adv Chronic Kidney Dis. 2017;24(1):22–30. https://​doi.​org/​10.​1053/​j.​ackd.​2016.​11.​005.PubMedCrossRef
Haley WE, Beckrich AL, Sayre J, McNeil R, Fumo P, Rao VM, et al. Improving care coordination between nephrology and primary care: a quality improvement initiative using the renal physicians association toolkit. Am J Kidney Dis. 2015;65(1):67–79. https://​doi.​org/​10.​1053/​j.​ajkd.​2014.​06.​031.PubMedCrossRef
Jolly SE, Navaneethan SD, Schold JD, Arrigain S, Konig V, Burrucker YK, et al. Development of a chronic kidney disease patient navigator program. BMC Nephrol. 2015;16(1):69. https://​doi.​org/​10.​1186/​s12882-015-0060-2.PubMedPubMedCentralCrossRef

Be confident that your patient care is up to date

Medicine Matters is being incorporated into Springer Medicine, our new medical education platform. 

Alongside the news coverage and expert commentary you have come to expect from Medicine Matters diabetes, Springer Medicine's complimentary membership also provides access to articles from renowned journals and a broad range of Continuing Medical Education programs. Create your free account »