Special Diabetes Care Needed for Those With Advanced CKD

TOPLINE:

Management of diabetes in people with advanced chronic kidney disease (CKD) is challenging due to certain unique aspects of assessment and treatment in these patients.

METHODOLOGY:

• Review and summary of important aspects of UK guidelines on management of hyperglycaemia in people with advanced CKD, defined as estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m², or on renal replacement therapy (including haemodialysis, peritoneal dialysis, and kidney transplantation).

TAKEAWAY:

• People with diabetes and advanced CKD are a vulnerable group of patients and require multidisciplinary management.
• These patients are often frail, with significant comorbidities, and at high risk for hypoglycaemia.
• Standard glycaemic assessment with glycated haemoglobin may not be valid due to anaemia, red cell turnover, or iron deficiency.
• Consideration should be given to the use of continuous glucose monitoring in people with diabetes on dialysis to aid in therapeutic decision-making.
• Regular screening for foot disease and eye disease is essential for people with diabetes on dialysis.
• Post-transplant diabetes can worsen renal outcomes and should be actively managed.
• Many glucose-lowering drug therapies are contraindicated in people with advanced CKD.
• Randomised controlled trials of glucose-lowering therapy have often excluded people with advanced CKD, so robust evidence is lacking.
• People with diabetes and advanced CKD may be most effectively managed in multi-disciplinary settings, with diabetes and renal specialists working together to ensure optimal management with patient-centred care.

IN PRACTICE:

“Progress is being made in the development of therapy to retard progression of CKD in people with diabetes, with the use of angiotensin converting enzyme inhibitors, angiotensin receptor blockers, sodium glucose transporter-2 inhibitors, and non-steroid mineralocorticoid receptor antagonists such as finerenone. Nevertheless, the number of people developing [end-stage kidney disease] with diabetes is growing,” the authors wrote.

SOURCE:

Written by Tahseen A. Chowdhury, Department of Diabetes, The Royal London Hospital, London, UK, and colleagues, this study was published online July 11, 2024, in Diabetic Medicine.

DISCLOSURES:

The authors have made no disclosures.