Current Strategies for Preventing Diabetic Kidney Disease

Diabetes is the most common cause of chronic kidney disease worldwide. Since there is a substantial increase in the prevalence of type 2 diabetes, it is likely that cases of diabetic kidney disease (DKD) will also rise unless some preventive measures are taken. DKD is associated with higher cardiovascular and all-cause mortality and morbidity; hence, prevention of DKD is essential. Classically, DKD evolves through several stages of normoalbuminuria, moderately increased albuminuria, and severely increased albuminuria. However, a substantial proportion of DKD has a nonproteinuric phenotype. Albuminuria and glomerular filtration rate (GFR) are important in renal and cardiovascular outcomes. The primary objective is to prevent the development of DKD, slow the progression of renal disease, and delay or prevent the onset of end-stage renal disease. Screening diabetics for the development of albuminuria is one of the important preventive strategies of DKD. In patients with established DKD, the ideal treatment goal is the preservation of GFR and regression of albuminuria. Preventing DKD involves a multifaceted approach out of which glycemic control and strict blood pressure control are of paramount importance. Furthermore, lipid control, smoking cessation, and metabolic control improve the renal outcomes. Based on large, randomized trials, renin-angiotensin system inhibition using angiotensin-converting enzyme inhibitors or angiotensin receptor blockers have been used to prevent the disease progression of DKD for many decades. In addition, therapies like sodium-glucose transport protein 2 inhibitors and nonsteroidal mineralocorticoid receptor antagonists have been now proven to retard the progression of DKD. Despite the mentioned developments in the field of DKD, there is still a need for more effective therapies to slow or reverse kidney damage.