Skip to main content
main-content
Top

02-27-2018 | Nephropathy | Review | Article

Comprehensive risk management of diabetic kidney disease in patients with type 2 diabetes mellitus

Journal: Diabetology International

Author: Shin-ichi Araki

Publisher: Springer Japan

share
SHARE

Abstract

Diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus is a leading cause of end-stage renal disease worldwide. An increase in the severity of albuminuria and a decrease in the glomerular filtration rate, by which the DKD stages are categorized, are associated with higher risks of not only end-stage renal disease but also all-cause mortality and cardiovascular mortality. Thus, an optimal management strategy and adequate assessment of therapeutic success are of great clinical and societal relevance to improve the prognosis in patients with type 2 diabetes mellitus and DKD. At present, comprehensive risk management for glycemia, blood pressure, lipid profile, and lifestyle habits is emphasized with respect to cardio-renal protection, rather than one single risk management approach. However, the pharmacological therapy aiming at strict control of these risk factors may be associated with an increased risk of adverse effects, particularly in older adults with diabetes. Accordingly, in the clinical practice of diabetes care, we need to individualize the treatment goals for each risk factor according to the health and social status of each patient with type 2 diabetes mellitus and DKD.
Literature
1.
Japanese Society for Dialysis Therapy. An overview of regular dialysis treatment in Japan. 2016. http://​docs.​jsdt.​or.​jp/​overview/​index.​html. Accessed 29 Jan 2018 (in Japanese).
2.
Fox CS, Matsushita K, Woodward M, Bilo HJ, Chalmers J, Heerspink HJ, Lee BJ, Perkins RM, Rossing P, Sairenchi T, Tonelli M, Vassalotti JA, Yamagishi K, Coresh J, de Jong PE, Wen CP, Nelson RG, Chronic Kidney Disease Prognosis Consortium. Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis. Lancet. 2012;380:1662–73. CrossRefPubMedPubMedCentral
3.
Wada T, Haneda M, Furuichi K, Babazono T, Yokoyama H, Iseki K, Araki S, Ninomiya T, Hara S, Suzuki Y, Iwano M, Kusano E, Moriya T, Satoh H, Nakamura H, Shimizu M, Toyama T, Hara A, Makino H. Research Group of Diabetic Nephropathy, Ministry of Health, Labour, and Welfare of Japan. Clin Exp Nephrol. 2014;18:613–20 CrossRefPubMed
4.
Adler AI, Stevens RJ, Manley SE, Bilous RW, Cull CA, Holman RR, UKPDS GROUP. Development and progression of nephropathy in type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney Int. 2003;63:225–32. CrossRefPubMed
5.
National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 Suppl 1):S1–266.
6.
Kramer HJ, Nguyen QD, Curhan G, Hsu CY. Renal insufficiency in the absence of albuminuria and retinopathy among adults with type 2 diabetes mellitus. JAMA. 2003;289:3273–7. CrossRefPubMed
7.
MacIsaac RJ, Tsalamandris C, Panagiotopoulos S, Smith TJ, McNeil KJ, Jerums G. Nonalbuminuric renal insufficiency in type 2 diabetes. Diabetes Care. 2004;27:195–200. CrossRefPubMed
8.
Yokoyama H, Araki S, Haneda M, Matsushima M, Kawai K, Hirao K, Oishi M, Sugimoto K, Sone H, Maegawa H, Kashiwagi A, Japan Diabetes Clinical Data Management Study Group. Chronic kidney disease categories and renal-cardiovascular outcomes in type 2 diabetes without prevalent cardiovascular disease: a prospective cohort study (JDDM25). Diabetologia. 2012;55:1911–8. CrossRefPubMed
9.
Afkarian M, Zelnick LR, Hall YN, Heagerty PJ, Tuttle K, Weiss NS, de Boer IH. Clinical manifestations of kidney disease among US adults with diabetes, 1988–2014. JAMA. 2016;316:602–10. CrossRefPubMedPubMedCentral
10.
Hidaka H, Terada M, Maegawa H, Kojima H, Koya D, Nishio Y, Haneda M, Yasuda H, Kashiwagi A, Kikkawa R. Evaluation of a new care system provided to diabetic patients in the outpatient clinic. Intern Med. 2000;39:783–7. CrossRefPubMed
11.
Araki S, Haneda M, Sugimoto T, Isono M, Isshiki K, Kashiwagi A, Koya D. Factors associated with frequent remission of microalbuminuria in patients with type 2 diabetes. Diabetes. 2005;54:2983–7. CrossRefPubMed
12.
Hsieh MC, Hsieh YT, Cho TJ, Chen JF, Lin SD, Chen HC, Tu ST. Remission of diabetic nephropathy in type 2 diabetic Asian population: role of tight glucose and blood pressure control. Eur J Clin Investig. 2011;41:870–8. CrossRef
13.
Yokoyama H, Araki S, Honjo J, Okizaki S, Yamada D, Shudo R, Shimizu H, Sone H, Moriya T, Haneda M. Association between remission of macroalbuminuria and preservation of renal function in patients with type 2 diabetes with overt proteinuria. Diabetes Care. 2013;36:3227–33. CrossRefPubMedPubMedCentral
14.
Gæde P, Tarnow L, Vedel P, Parving HH, Pedersen O. Remission to normoalbuminuria during multifactorial treatment preserves kidney function in patients with type 2 diabetes and microalbuminuria. Nephrol Dial Transplant. 2004;19:2784–8. CrossRefPubMed
15.
Makino H, Haneda M, Babazono T, Moriya T, Ito S, Iwamoto Y, Kawamori R, Takeuchi M, Katayama S, INNOVATION Study Group. Microalbuminuria reduction with telmisartan in normotensive and hypertensive Japanese patients with type 2 diabetes: a post hoc analysis of The Incipient to Overt: angiotensin II Blocker, Telmisartan, Investigation on Type 2 Diabetic Nephropathy (INNOVATION) study. Hypertens Res. 2008;31:657–64. CrossRefPubMed
16.
Perkovic V, Heerspink HL, Chalmers J, Woodward M, Jun MLIQ, MacMahon S, Cooper ME, Hamet P, Marre M, Mogensen CE, Poulter N, Mancia G, Cass A, Patel A, Zoungas S, ADVANCE Collaborative Group. Intensive glucose control improves kidney outcomes in patients with type 2 diabetes. Kidney Int. 2013;83:517–23. CrossRefPubMed
17.
Gregg EW, Li Y, Wang J, Burrows NR, Ali MK, Rolka D, Williams DE, Geiss L. Changes in diabetes-related complications in the United States, 1990–2010. N Engl J Med. 2014;370:1514–23. CrossRefPubMed
18.
Haneda M, Utsunomiya K, Koya D, Babazono T, Moriya T, Makino H, Kimura K, Suzuki Y, Wada T, Ogawa S, Inaba M, Kanno Y, Shigematsu T, Masakane I, Tsuchiya K, Honda K, Ichikawa K, Shide K, Joint Committee on Diabetic Nephropathy. A new classification of diabetic nephropathy 2014: a report from Joint committee on diabetic nephropathy. J Diabetes Investig. 2015;6:242–6. CrossRef
19.
UK Prospective Diabetes Study UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33. Lancet. 1998;352:837–53. CrossRef
20.
Ohkubo Y, Kishikawa H, Araki E, Miyata T, Isami S, Motoyoshi S, Kojima Y, Furuyoshi N, Shichiri M. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract. 1995;28:103–17. CrossRefPubMed
21.
Lewis EJ, Hunsicker LG, Clarke WR, Berl T, Pohl MA, Lewis JB, Ritz E, Atkins RC, Rohde I, Raz R, Collaborative Study Group. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med. 2001;345:851–60. CrossRefPubMed
22.
Brenner BM, Cooper ME, de Zeeuw D, Keane WF, Mitch WE, Parving HH, Remuzzi G, Snapinn SM, Zhang Z, Shahinfar S, RENAAL Study Investigators. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med. 2001;345:861–9. CrossRefPubMed
23.
Parving HH, Lehnert H, Bröchner-Mortensen J, Gomis R, Andersen S, Arner P, Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria Study Group. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med. 2001;345:870–8. CrossRefPubMed
24.
Gæde P, Vedel P, Larsen N, Jensen GV, Parving H-H, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003;348:383–93. CrossRefPubMed
25.
Gæde P, Lund-Andersen H, Parving H-H, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med. 2008;358:580–91. CrossRefPubMed
26.
Gæde P, Oellgaard J, Carstensen B, Rossing P, Lund-Andersen H, Parving HH, Pedersen O. Years of life gained by multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: 21 years follow-up on the Steno-2 randomised trial. Diabetologia. 2016;59:2298–307. CrossRefPubMedPubMedCentral
27.
Oellgaard J, Gæde 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;91:982–8. CrossRefPubMed
28.
Joss N, Ferguson C, Brown C, Deighan CJ, Paterson KR, Boulton-Jones JM. Intensified treatment of patients with type 2 diabetes mellitus and overt nephropathy. QJM. 2004;97:219–27. CrossRefPubMed
29.
Tu ST, Chang SJ, Chen JF, Tien KJ, Hsiao JY, Chen HC, Hsieh MC. Prevention of diabetic nephropathy by tight target control in an asian population with type 2 diabetes mellitus: a 4-year prospective analysis. Arch Intern Med. 2010;170:155–61. CrossRefPubMed
30.
Sandbæk A, Griffin SJ, Sharp SJ, Simmons RK, Borch-Johnsen K, Rutten GE, van den Donk M, Wareham NJ, Lauritzen T, Davies MJ, Khunti K. Effect of early multifactorial therapy compared with routine care on microvascular outcomes at 5 years in people with screen-detected diabetes: a randomized controlled trial: the ADDITION-Europe Study. Diabetes Care. 2014;37:2015–23. CrossRefPubMed
31.
Chan JC, So WY, Yeung CY, Ko GT, Lau IT, Tsang MW, Lau KP, Siu SC, Li JK, Yeung VT, Leung WY, Tong PC, SURE Study Group. Effects of structured versus usual care on renal endpoint in type 2 diabetes: the SURE study: a randomized multicenter translational study. Diabetes Care. 2009;32:977–82. CrossRefPubMedPubMedCentral
32.
Fogelfeldl Hart P, Miernik J, Ko J, Calvin D, Tahsin B, Adhami A, Mehrotra R, Fogg L. Combined diabetes-renal multifactorial intervention in patients with advanced diabetic nephropathy: proof-of-concept. J Diabetes Complications 2017;31:624–30. CrossRefPubMed
33.
Fioretto P, Steffes MW, Sutherland DE, Goetz FC, Mauer M. Reversal of lesions of diabetic nephropathy after pancreas transplantation. N Engl J Med. 1998;339:69–75. CrossRefPubMed
34.
de Zeeuw D, Remuzzi G, Parving HH, Keane WF, Zhang Z, Shahinfar S, Snapinn S, Cooper ME, Mitch WE, Brenner BM. Proteinuria, a target for renoprotection in patients with type 2 diabetic nephropathy: lessons from RENAAL. Kidney Int. 2004;65:2309–20. CrossRefPubMed
35.
Araki S, Haneda M, Koya D, Hidaka H, Sugimoto T, Isono M, Isshiki K, Chin-Kanasaki M, Uzu T, Kashiwagi A. Reduction in microalbuminuria as an integrated indicator for renal and cardiovascular risk reduction in patients with type 2 diabetes. Diabetes. 2007;56:1727–30. CrossRefPubMed
36.
de Zeeuw D, Remuzzi G, Parving HH, Keane WF, Zhang Z, Shahinfar S, Snapinn S, Cooper ME, Mitch WE, Brenner BM. Albuminuria, a therapeutic target for cardiovascular protection in type 2 diabetic patients with nephropathy. Circulation. 2004;110:921–7. CrossRefPubMed
37.
Zandbergen AA, Vogt L, de Zeeuw D, Lamberts SW, Ouwendijk RJ, Baggen MG, Bootsma AH. Change in albuminuria is predictive of cardiovascular outcome in normotensive patients with type 2 diabetes and microalbuminuria. Diabetes Care. 2007;30:3119–21. CrossRefPubMed
38.
Jun M, Ohkuma T, Zoungas S, Colagiuri S, Mancia G, Marre M, Matthews D, Poulter N, Williams B, Rodgers A, Perkovic V, Chalmers J, Woodward M, ADVANCE Collaborative Group. Changes in albuminuria and the risk of major clinical outcomes in diabetes: results from ADVANCE-ON. Diabetes Care. 2018;41:163–70. CrossRefPubMed
39.
Miyazawa I, Kadota A, Okamoto M, Miura K, Maegawa H, Ohnishi A, For the Shiga Diabetes Clinical Survey Group. Trends in medical performance in diabetic patients in primary care clinics compared with those in hospitals: Shiga Diabetes Clinical Survey, Japan, 2000–2012. Diabetol Int. 2017;8:59–68. CrossRef
40.
Ueki K, Sasako T, Okazaki Y, Kato M, Okahata S, Katsuyama H, Haraguchi M, Morita A, Ohashi K, Hara K, Morise A, Izumi K, Ishizuka N, Ohashi Y, Noda M, Kadowaki T, J-DOIT3 Study Group. Effect of an intensified multifactorial intervention on cardiovascular outcomes and mortality in type 2 diabetes (J-DOIT3): an open-label, randomised controlled trial. Lancet Diabetes Endocrinol. 2017;5:951–64. CrossRefPubMed
41.
Tajima N, Noda M, Origasa H, Noto H, Yabe D, Fujita Y, Goto A, Fujimoto K, Sakamoto M, Haneda M. Evidence-based practice guideline for the treatment for diabetes in Japan 2013. Diabetol Int. 2015;6:151–87. CrossRef
42.
Sone H, Tanaka S, Tanaka S, Iimuro S, Oida K, Yamasaki Y, Oikawa S, Ishibashi S, Katayama S, Ohashi Y, Akanuma Y, Yamada N, Japan Diabetes Complications Study Group. Serumlevel of triglycerides is a potent risk factor comparable to LDL cholesterol for coronary heart disease in Japanese patients with type 2 diabetes: subanalysis of the Japan Diabetes Complications Study (JDCS). J Clin Endocrinol Metab. 2011;96:3448–56. CrossRefPubMed
43.
Yokoyama H, Oishi M, Takamura H, Yamasaki K, Shirabe SI, Uchida D, Sugimoto H, Kurihara Y, Araki SI, Maegawa H. Large-scale survey of rates of achieving targets for blood glucose, blood pressure, and lipids and prevalence of complications in type 2 diabetes (JDDM 40). BMJ Open Diabetes Res Care. 2016;4:e000294. CrossRefPubMedPubMedCentral
44.
Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and trends in diabetes among adults in the United States, 1988–2012. JAMA. 2015;314:1021–9. CrossRefPubMed
45.
Whitmer RA, Karter AJ, Yaffe K, Quesenberry CP Jr, Selby JV. Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. JAMA. 2009;301:1565–72. CrossRefPubMedPubMedCentral
46.
Goto A, Arah OA, Goto M, Terauchi Y, Noda M. Severe hypoglycaemia and cardiovascular disease: systematic review and meta-analysis with bias analysis. BMJ. 2013;347:f4533. CrossRefPubMed
47.
Huang ES, Laiteerapong N, Liu JY, John PM, Moffet HH, Karter AJ. Rates of complications and mortality in older patients with diabetes mellitus: the diabetes and aging study. JAMA Intern Med. 2014;174:251–8. CrossRefPubMedPubMedCentral
48.
Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions, and Complications Study Research Group, Jacobson AM, Musen G, Ryan CM, Silvers N, Cleary P, Waberski B, Burwood A, Weinger K, Bayless M, Dahms W, Harth J. Long-term effect of diabetes and its treatment on cognitive function. N Engl J Med. 2007;356:1842–52. CrossRef
49.
IDF Global Guideline. Managing older people with type 2 diabetes: glucose control management and targets. 2013;30–36. https://​www.​idf.​org/​e-library/​guidelines.​html.
50.
American Diabetes Association. Older adults: standards of medical care in diabetes—2018. Diabetes Care. 2018;41(Supplement 1):S119–25. CrossRef
51.
Japan Diabetes Society (JDS)/Japan Geriatrics Society (JGS) Joint Committee on Improving Care for Elderly Patients with Diabetes, Haneda M, Ito H. Glycemic targets for elderly patients with diabetes. Glycemic targets for elderly patients with diabetes. Diabetol Int. 2016;7:331–3. CrossRef
52.
Miao Y, Dobre D, Heerspink HJ, Brenner BM, Cooper ME, Parving HH, Shahinfar S, Grobbee D, de Zeeuw D. Increased serum potassium affects renal outcomes: a post hoc analysis of the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) trial. Diabetologia. 2011;54:44–50. CrossRefPubMed
53.
Andrésdóttir G, Jensen ML, Carstensen B, Parving HH, Rossing K, Hansen TW, Rossing P. Improved survival and renal prognosis of patients with type 2 diabetes and nephropathy with improved control of risk factors. Diabetes Care. 2014;37:1660–7. CrossRefPubMed
54.
Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S, Mattheus M, Devins T, Johansen OE, Woerle HJ, Broedl UC, Inzucchi SE, EMPA-REG OUTCOME Investigators. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373:2117–28. CrossRefPubMed
55.
Neal B, Perkovic V, Mahaffey KW, de Zeeuw D, Fulcher G, Erondu N, Shaw W, Law G, Desai M, Matthews DR, CANVAS Program Collaborative Group. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017;377:644–57. CrossRefPubMed
56.
Wanner C, Inzucchi SE, Lachin JM, Fitchett D, von Eynatten M, Mattheus M, Johansen OE, Woerle HJ, Broedl UC, Zinman B. Empagliflozin and progression of kidney disease in type 2 diabetes. N Engl J Med. 2016;375:323–34. CrossRefPubMed
57.
Heerspink HJ, Perkins BA, Fitchett DH, Husain M, Cherney DZ. Sodium glucose cotransporter 2 inhibitors in the treatment of diabetes mellitus: cardiovascular and kidney effects, potential mechanisms, and clinical applications. Circulation. 2016;134:752–72. CrossRefPubMed
58.
Kashiwagi A, Maegawa H. Metabolic and hemodynamic effects of sodium-dependent glucose cotransporter 2 inhibitors on cardio-renal protection in the treatment of patients with type 2 diabetes mellitus. J Diabetes Investig. 2017;8:416–27. CrossRefPubMedPubMedCentral
59.
Tonneijck L, Muskiet MH, Smits MM, van Bommel EJ, Heerspink HJ, van Raalte DH, Joles JA. Glomerular hyperfiltration in diabetes: mechanisms, clinical significance, and treatment. J Am Soc Nephrol. 2017;28:1023–39. CrossRefPubMedPubMedCentral

New additions to the Adis Journal Club

A selection of topical peer-reviewed articles from the Adis journals, curated by the editors.

GLP-1 receptor agonists

Browse the latest news, clinical trial updates, and expert commentary.