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      The Landscape of Diabetic Kidney Disease in the United States

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          Abstract

          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.

          Summary

          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.

          Electronic supplementary material

          The online version of this article (10.1007/s11892-018-0980-x) contains supplementary material, which is available to authorized users.

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          Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes.

          Peter Gæde, Pernille Vedel, Nicolai H. Larsen … (2003)
          Cardiovascular morbidity is a major burden in patients with type 2 diabetes. In the Steno-2 Study, we compared the effect of a targeted, intensified, multifactorial intervention with that of conventional treatment on modifiable risk factors for cardiovascular disease in patients with type 2 diabetes and microalbuminuria. The primary end point of this open, parallel trial was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, revascularization, and amputation. Eighty patients were randomly assigned to receive conventional treatment in accordance with national guidelines and 80 to receive intensive treatment, with a stepwise implementation of behavior modification and pharmacologic therapy that targeted hyperglycemia, hypertension, dyslipidemia, and microalbuminuria, along with secondary prevention of cardiovascular disease with aspirin. The mean age of the patients was 55.1 years, and the mean follow-up was 7.8 years. The decline in glycosylated hemoglobin values, systolic and diastolic blood pressure, serum cholesterol and triglyceride levels measured after an overnight fast, and urinary albumin excretion rate were all significantly greater in the intensive-therapy group than in the conventional-therapy group. Patients receiving intensive therapy also had a significantly lower risk of cardiovascular disease (hazard ratio, 0.47; 95 percent confidence interval, 0.24 to 0.73), nephropathy (hazard ratio, 0.39; 95 percent confidence interval, 0.17 to 0.87), retinopathy (hazard ratio, 0.42; 95 percent confidence interval, 0.21 to 0.86), and autonomic neuropathy (hazard ratio, 0.37; 95 percent confidence interval, 0.18 to 0.79). A target-driven, long-term, intensified intervention aimed at multiple risk factors in patients with type 2 diabetes and microalbuminuria reduces the risk of cardiovascular and microvascular events by about 50 percent. Copyright 2003 Massachusetts Medical Society
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            KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease.

            (2007)
            Article 0 comments Cited 370 times – based on 0 reviews     Review now
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              Achievement of goals in U.S. diabetes care, 1999-2010.

              Mohammed Ali, Kai McKeever Bullard, Jinan B Saaddine … (2013)
              Tracking national progress in diabetes care may aid in the evaluation of past efforts and identify residual gaps in care. We analyzed data for adults with self-reported diabetes from the National Health and Nutrition Examination Survey and the Behavioral Risk Factor Surveillance System to examine risk-factor control, preventive practices, and risk scores for coronary heart disease over the 1999-2010 period. From 1999 through 2010, the weighted proportion of survey participants who met recommended goals for diabetes care increased, by 7.9 percentage points (95% confidence interval [CI], 0.8 to 15.0) for glycemic control (glycated hemoglobin level <7.0%), 9.4 percentage points (95% CI, 3.0 to 15.8) for individualized glycemic targets, 11.7 percentage points (95% CI, 5.7 to 17.7) for blood pressure (target, <130/80 mm Hg), and 20.8 percentage points (95% CI, 11.6 to 30.0) for lipid levels (target level of low-density lipoprotein [LDL] cholesterol, <100 mg per deciliter [2.6 mmol per liter]). Tobacco use did not change significantly, but the 10-year probability of coronary heart disease decreased by 2.8 to 3.7 percentage points. However, 33.4 to 48.7% of persons with diabetes still did not meet the targets for glycemic control, blood pressure, or LDL cholesterol level. Only 14.3% met the targets for all three of these measures and for tobacco use. Adherence to the recommendations for annual eye and dental examinations was unchanged, but annual lipid-level measurement and foot examination increased by 5.5 percentage points (95% CI, 1.6 to 9.4) and 6.8 percentage points (95% CI, 4.8 to 8.8), respectively. Annual vaccination for influenza and receipt of pneumococcal vaccination for participants 65 years of age or older rose by 4.5 percentage points (95% CI, 0.8 to 8.2) and 6.9 percentage points (95% CI, 3.4 to 10.4), respectively, and daily glucose monitoring increased by 12.7 percentage points (95% CI, 10.3 to 15.1). Although there were improvements in risk-factor control and adherence to preventive practices from 1999 to 2010, tobacco use remained high, and almost half of U.S. adults with diabetes did not meet the recommended goals for diabetes care.
              Article 0 comments Cited 341 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                O. Kenrik Duru: (310)794-8138 , Kduru@mednet.ucla.edu
                Journal
                Journal ID (nlm-ta): Curr Diab Rep
                Journal ID (iso-abbrev): Curr. Diab. Rep
                Title: Current Diabetes Reports
                Publisher: Springer US (New York )
                ISSN (Print): 1534-4827
                ISSN (Electronic): 1539-0829
                Publication date (Electronic): 19 February 2018
                Publication date PMC-release: 19 February 2018
                Publication date (Print): 2018
                Volume: 18
                Issue: 3
                Electronic Location Identifier: 14
                Affiliations
                [1 ]ISNI 0000 0000 9632 6718, GRID grid.19006.3e, Department of Medicine, Division of General Internal Medicine/Health Services Research, , David Geffen School of Medicine at the University of California, Los Angeles, ; 10940 Wilshire Blvd, Suite 700, Los Angeles, CA 90024 USA
                [2 ]ISNI 0000 0004 0572 4227, GRID grid.431072.3, AbbVie, ; North Chicago, IL USA
                Article
                Publisher ID: 980
                DOI: 10.1007/s11892-018-0980-x
                PMC ID: 5817078
                PubMed ID: 29457196
                SO-VID: 3f7b28f8-3484-49b8-ab4c-0db0f6241f98
                Copyright © © The Author(s) 2018
                License:

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Categories
                Subject: Microvascular Complications—Nephropathy (M Afkarian and B Roshanravan, Section Editors)
                Custom metadata
                issue-copyright-statement © Springer Science+Business Media, LLC, part of Springer Nature 2018

                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: albuminuria,diabetes,diabetic kidney disease,chronic kidney disease
                Data availability:
                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: albuminuria, diabetes, diabetic kidney disease, chronic kidney disease

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