{"id":6667,"date":"2025-01-02T14:43:37","date_gmt":"2025-01-02T10:43:37","guid":{"rendered":"https:\/\/kardio.az\/?p=6667"},"modified":"2025-01-02T14:43:37","modified_gmt":"2025-01-02T10:43:37","slug":"chronic-kidney-disease-and-risk-management-standards-of-care-in-diabetes-2024","status":"publish","type":"post","link":"https:\/\/kardio.az\/en\/hekimler-ucun\/chronic-kidney-disease-and-risk-management-standards-of-care-in-diabetes-2024\/","title":{"rendered":"Chronic Kidney Disease and Risk Management:\u00a0Standards of Care in Diabetes\u20142024"},"content":{"rendered":"

Diabetes Care<\/em> 2024;47(Supplement_1):S219\u2013S230<\/p>\n\n\n\n

https:\/\/doi.org\/10.2337\/dc24-S011<\/a><\/p>\n\n\n\n

The American Diabetes Association (ADA) \u201cStandards of Care in Diabetes\u201d includes the ADA\u2019s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA\u2019s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to\u00a0Introduction and Methodology<\/a>. Readers who wish to comment on the Standards of Care are invited to do so at\u00a0professional.diabetes.org\/SOC<\/a>.<\/p>\n\n\n\n

Chronic Kidney Disease<\/h2>\n\n\n\n

Screening<\/h3>\n\n\n\n

Recommendations<\/h4>\n\n\n\n
    \n
  • 11.1a<\/strong>\u00a0At least annually, urinary albumin (e.g., spot urinary albumin-to-creatinine ratio [UACR]) and estimated glomerular filtration rate [eGFR] should be assessed in people with type 1 diabetes with duration of \u22655 years and in all people with type 2 diabetes regardless of treatment.\u00a0B<\/strong><\/li>\n\n\n\n
  • 11.1b<\/strong>\u00a0In people with established chronic kidney disease (CKD), urinary albumin (e.g., spot UACR) and eGFR should be monitored 1\u20134 times per year depending on the stage of the kidney disease\u00a0<\/li>\n\n\n\n
  • 11.2<\/strong>\u00a0Optimize glucose management to reduce the risk or slow the progression of CKD.\u00a0A<\/strong><\/li>\n\n\n\n
  • 11.3<\/strong>\u00a0Optimize blood pressure control and reduce blood pressure variability to reduce the risk or slow the progression of CKD and reduce cardiovascular risk.\u00a0A<\/strong><\/li>\n\n\n\n
  • 11.4a<\/strong>\u00a0In nonpregnant people with diabetes and hypertension, either an ACE inhibitor or an angiotensin receptor blocker (ARB) is recommended for those with moderately increased albuminuria (UACR 30\u2013299 mg\/g creatinine)\u00a0B<\/strong>\u00a0and is strongly recommended for those with severely increased albuminuria (UACR \u2265300 mg\/g creatinine) and\/or eGFR <60 mL\/min\/1.73 m2<\/sup>\u00a0to prevent the progression of kidney disease and reduce cardiovascular events.\u00a0A<\/strong><\/li>\n\n\n\n
  • 11.4b<\/strong>\u00a0Periodically monitor for increased serum creatinine and potassium levels when ACE inhibitors, ARBs, and mineralocorticoid receptor antagonists are used, or for hypokalemia when diuretics are used.\u00a0B<\/strong><\/li>\n\n\n\n
  • 11.4c<\/strong>\u00a0An ACE inhibitor or an ARB is not recommended for the primary prevention of CKD in people with diabetes who have normal blood pressure, normal UACR (<30 mg\/g creatinine), and normal eGFR.\u00a0A<\/strong><\/li>\n\n\n\n
  • 11.4d<\/strong>\u00a0Do not discontinue renin-angiotensin system blockade for mild to moderate increases in serum creatinine (\u226430%) in the absence of signs of extracellular fluid volume depletion.\u00a0A<\/strong><\/li>\n\n\n\n
  • 11.5a<\/strong>\u00a0For people with type 2 diabetes and CKD, use of a sodium\u2013glucose cotransporter 2 (SGLT2) inhibitor is recommended to reduce CKD progression and cardiovascular events in individuals with eGFR \u226520 mL\/min\/1.73 m2<\/sup>\u00a0and urinary albumin \u2265200 mg\/g creatinine.\u00a0A<\/strong><\/li>\n\n\n\n
  • 11.5b<\/strong>\u00a0For people with type 2 diabetes and CKD, use of an SGLT2 inhibitor is recommended to reduce CKD progression and cardiovascular events in individuals with eGFR \u226520 mL\/min\/1.73 m2<\/sup>\u00a0and urinary albumin ranging from normal to 200 mg\/g creatinine.\u00a0B<\/strong><\/li>\n\n\n\n
  • 11.5c<\/strong>\u00a0For cardiovascular risk reduction in people with type 2 diabetes and CKD, consider use of an SGLT2 inhibitor (if eGFR is \u226520 mL\/min\/1.73 m2<\/sup>), a glucagon-like peptide 1 agonist, or a nonsteroidal mineralocorticoid receptor antagonist (if eGFR is \u226525 mL\/min\/1.73 m2<\/sup>).\u00a0A<\/strong><\/li>\n\n\n\n
  • 11.5d<\/strong>\u00a0As people with CKD and albuminuria are at increased risk for cardiovascular events and CKD progression, a nonsteroidal mineralocorticoid receptor antagonist that has been shown to be effective in clinical trials is recommended to reduce cardiovascular events and CKD progression (if eGFR is \u226525 mL\/min\/1.73 m2<\/sup>). Potassium levels should be monitored.\u00a0A<\/strong><\/li>\n\n\n\n
  • 11.6<\/strong>\u00a0In people with CKD who have \u2265300 mg\/g urinary albumin, a reduction of 30% or greater in mg\/g urinary albumin is recommended to slow CKD progression.\u00a0C<\/strong><\/li>\n\n\n\n
  • 11.7<\/strong>\u00a0For people with non\u2013dialysis-dependent stage G3 or higher CKD, dietary protein intake should be aimed to a target level of 0.8 g\/kg body weight per day.\u00a0A<\/strong>\u00a0For individuals on dialysis, 1.0\u20131.2 g\/kg\/day of dietary protein intake should be considered since protein energy wasting is a major problem in some individuals on dialysis.\u00a0B<\/strong><\/li>\n\n\n\n
  • 11.8<\/strong>\u00a0Individuals should be referred for evaluation by a nephrologist if they have continuously increasing urinary albumin levels and\/or continuously decreasing eGFR and\/or if the eGFR is <30 mL\/min\/1.73 m2<\/sup>.\u00a0A<\/strong><\/li>\n\n\n\n
  • 11.9<\/strong>\u00a0Promptly refer to a nephrologist for uncertainty about the etiology of kidney disease, difficult management issues, and rapidly progressing kidney disease.\u00a0B<\/strong><\/li>\n<\/ul>\n\n\n\n
    \"\"<\/figure>\n\n\n\n

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    <\/p>","protected":false},"excerpt":{"rendered":"

    Diabetes Care 2024;47(Supplement_1):S219\u2013S230 https:\/\/doi.org\/10.2337\/dc24-S011 The American Diabetes Association (ADA) \u201cStandards of Care in Diabetes\u201d includes the ADA\u2019s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible…<\/p>","protected":false},"author":4,"featured_media":6670,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[26],"tags":[],"class_list":["post-6667","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-hekimler-ucun"],"_links":{"self":[{"href":"https:\/\/kardio.az\/en\/wp-json\/wp\/v2\/posts\/6667","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kardio.az\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kardio.az\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kardio.az\/en\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/kardio.az\/en\/wp-json\/wp\/v2\/comments?post=6667"}],"version-history":[{"count":1,"href":"https:\/\/kardio.az\/en\/wp-json\/wp\/v2\/posts\/6667\/revisions"}],"predecessor-version":[{"id":6671,"href":"https:\/\/kardio.az\/en\/wp-json\/wp\/v2\/posts\/6667\/revisions\/6671"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/kardio.az\/en\/wp-json\/wp\/v2\/media\/6670"}],"wp:attachment":[{"href":"https:\/\/kardio.az\/en\/wp-json\/wp\/v2\/media?parent=6667"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kardio.az\/en\/wp-json\/wp\/v2\/categories?post=6667"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kardio.az\/en\/wp-json\/wp\/v2\/tags?post=6667"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}