Optimizing Outcomes in Patients with Diabetic Kidney Disease

Target Audience
Primary care physicians; nurse practitioners; physician assistants; and other clinicians involved in the care of patients with Diabetic Kidney Disease.

Course Summary
Diabetic kidney disease (DKD), is estimated to affect 20-40% of patients with diabetes mellitus and is the leading cause of end-stage renal disease (ESRD). All-cause mortality in patients with DKD is 30-fold higher than in individuals who have diabetes without chronic kidney disease (CKD), and many of these deaths are due to cardiovascular disease (CVD), rather than to ESRD. Treatment for DKD recently evolved to include sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs), which have demonstrated cardiorenal benefits. Emerging treatments such as non-steroidal selective mineralocorticoid receptor antagonists (MRAs) have the potential to further reduce CVD risk and DKD progression. As newer agents begin to emerge to further reduce renal risk in patients with diabetes, clinicians need to be aware of them and their MOA so they can rapidly integrate them into practice as they become available. Using video clips taken from a live broadcast presented as part of Emerging Challenges and Clinical Updates in Primary Care 2020, this activity will address strategies to screen for DKD, discuss the impact of inflammation and fibrosis on cardiovascular risk, and identify treatment approaches to optimize care of patients with type 2 diabetes and decrease risk of progression of DKD.

Learning Objectives
Upon completion of this activity, participants should be better able to:

Utilize recommended screening strategies to ensure early diagnosis of chronic kidney disease (CKD) in patients with diabetes, including the use of urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR).
Discuss how diabetic kidney disease (DKD) confers a high risk of cardiovascular disease (CVD), renal events, and associated mortality and implications for management.
Discuss the role of inflammation, fibrosis and the mineralocorticoid receptor in the progression of CKD.
Incorporate current treatment approaches and discuss novel treatment approaches based on current and emerging data, to optimize the care of patients with type 2 diabetes and decrease the risk of progression of DKD.