KIDNEY HEALTH FOR ALL

CARING FOR THE KIDNEYS

DR. JOSEFINA LAZA-LUSPIAN MARCH 8, 2024

Sun Tzu

"If you know the enemy and know yourself, you need not fear the result of a
hundred battles..."
 Our enemy: Kidney disease which continues to be on the rise

--increasing number of patients with kidney failure

--increasing number of patients on dialysis
-- increasing number of dialysis centers
-- increasing number of kidney transplantations

In order for us to prevent this serious disease, we need to be familiar with its nature, causes, and prevention

We also need to EMPOWER OURSELVES and actively participate in preventing or stopping the enemy
Should kidney disease and kidney failure be a way of life?
Should dialysis be a way of life?

Expensive
Treatment entails pain- frequent blood tests
Quality of life is affected: poor sleep, food restrictions, poor appetite
Hemodialysis- 3-5 times a week, needle pricks

Peritoneal dialysis- tube in the stomach, daily procedure

FAQ: "Pag nasimulan po ba ang dialysis ay pang- lifetime na?"

2 TYPES of KIDNEY FAILURE

1. Acute- sudden, reversible if detected and treated early

-high death rate if severe and not treated adequately
- occurs in days to weeks
- IF Severe: temporary dialysis

2. Chronic - 3 months or more.. not reversible

1. Acute Kidney Injury
= sudden, reversible if treated early
causes: dehydration due to diarrhea, excessive vomiting
blood loss due to injuries
Leptospirosis=inflammation of kidneys
Severe infection
Prevention, early treatment

2. Chronic Kidney Disease or "CKD"

=develops very slowly, usually a silent disease until late stage
=Irreversible
=lifetime dialysis or kidney transplant
... Scarring, gradual decline in kidney function
THE KIDNEYS
1 million nephrons in each kidney
The kidneys are as important as the brain and the heart
THE KIDNEYS
FUNCTIONS

1. cleanse the body of waste products or toxins

2. remove excess water, salt
3. maintain electrolyte balance- sodium, potassium
4. produce the hormone erythropoietin that helps in producing red blood cells
5. produce the hormone that converts Vit D to its active form- calcium
absorption
6. maintain acid base balance
TOPIC OUTLINE
1. The Kidneys and their Functions
3. Causes of Kidney Disease
4. Detection of Kidney Disease
5.Management of Kidney Disease
 While up to 50%
of patients with
T2D have CKD
CKD is a medical and public health
burden
globally6, the
majority of
patients (50-70%)
have CKD
without diabetes7

An estimated 5−10 million people

CKD affects approximately 1 in 10
with CKD die each year, primarily from
adults or about 850 million people1–3
CKD-related cardiovascular disease7

CKD affects up to 40% of patients with

African Americans, Hispanics, and
T2D globally4–6, and about 20% of
American Indians are at high risk for
patients with CKD also have HF3
developing ESKD8

In developed countries, mean annual total

CKD is the most common reason healthcare costs of a patient with CKD stage
for progression to ESKD in many 4-5 are US ~$5000−53,000, increasing to
parts of the world4–6 ~$20,000−100,000 in ESKD9

This material is for educational purposes only with the intent to communicate the EMPA-KIDNEY full trial results. Empagliflozin is not indicated for the treatment of patients
with chronic kidney disease in the Philippines. Please refer to the local approved product information for the current indication
CKD, chronic kidney disease; ESKD, end-stage kidney disease; HF, heart failure; T2D, type 2 diabetes
1. Mills KT et al. Kidney Int 2015;88:950; 2. International Society of Nephrology. Global Kidney Health Atlas, 2019. https://www.theisn.org/initiatives/global-kidney-health-atlas/ (accessed May
2022); 3. Jager KJ et al. Nephrol Dial Transplant 2019;34:1803; 4. Thomas M et al. Nat Rev Nephrol 2016;12:73; 5. Toth-Manikowski S & Atta MG. J Diabetes Res 2015:697010; 6. Umanath K et al.
Am J Kidney Dis 2018;71(6):884-95; 7. House AA et al. Kidney Int 2019;95:1304; 8. National Kidney Foundation. Race, Ethnicity, & Kidney Disease. Available here:
https://www.niddk.nih.gov/health-information/kidney-disease/race-ethnicity (accessed May 2022); 9. Elshatat S et al. PLoS ONE 15:e0230512
In the Philippines, it is estimated that

-around 2.5 million Filipinos have chronic kidney disease

-NKTI estimates that 1 Filipino develops chronic kidney failure every hour

CKD currently costs more than breast, lung, colon, and skin cancer combined
 CKD is associated with multiple risk factors

While up to 50%
Dyslipidemia1 of patients with
T2D have CKD
globally6, the
60+
majority of
years old2,3 patients (50-70%)
Diabetes2

CKD
have CKD
without diabetes7
Tobacco Kidney failure is the
Hypertension 2
use4 most severe
complication of
CKD, and diabetes
CV disease5 Family is the most common
history2 reason for
progression to
kidney failure8,9
Obesity2

CKD, chronic kidney disease; T2D, type 2 diabetes; CV, cardiovascular

This material is for educational purposes only with the intent to communicate the EMPA-KIDNEY full trial results. Empagliflozin is not indicated for the treatment of patients with chronic kidney
disease in the Philippines. Please refer to the local approved product information for the current indication

1. Trevisan R, et al. J Am Soc Nephrol. 2006;17:145–147. 2. Kazancioğlu R. Kidney Int Suppl. 2013;3(4):368–371. 3. National Kidney Foundation. Aging and
Kidney Disease. Available at: https://www.kidney.org/news/monthly/wkd_aging. Accessed December 2021. 4. Jo W, et al. PLoS One. 2020;15:e0238111. 5. Menon
V, et al. Kidney International. 2005;68:1413–1418. 6. Thomas M et al. Nat Rev Nephrol. 2016;12(2):73-81. 7. Jha V, et al. Lancet. 2013;382(9888):260–272. 8.
Toth-Manikowski S & Atta MG. J Diabetes Res. 2015;697010. 9. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney
Disease. Kidney Int Suppl. 2013;3(1):1–150.
 Diabetes is the most common cause of CKD, followed
by hypertension

50% of T2D patients show evidence of CKD

(albuminuria, impaired GFR or both)*2
Other Prevalence of microalbuminuria or worse increase as
886.03 duration of diabetes increases (N=5097)†3
(22%) Diabetes
1690.73 30 28.0

Proportion of patients %
(42%) 24.9
Glomerulonephritis 22.5
735.69 17.3
(18%) 15

Hypertension 7.3
7.5
744.10
(18%)
0
At diagnosis 5 years 10 years 15 years
Age-standardised global prevalence rate of CKD Duration of Diabetes
by cause per 100,000 persons in 20161
This material is for educational purposes only with the intent to communicate the EMPA-KIDNEY full trial results. Empagliflozin is not indicated for the treatment of
patients with chronic kidney disease in the Philippines. Please refer to the local approved product information for the current indication

*In a study of patients with T2D but without a known history of proteinuria and/or kidney disease; †At 15 years, 435 patients were alive and examined
CKD, chronic kidney disease; GFR, glomerular filtration rate; T2D, type 2 diabetes
Most common causes of kidney disease
1. Diabetes Mellitus
2. High blood pressure
3. Chronic Glomerulonephritis
4. Kidney Damage Due to Frequent Use of Pain Killers
5. Obstructive Uropathy
6. Polycystic Kidney Disease
CHRONIC KIDNEY DISEASE: 5 stages
Staging is based on kidney function
="estimated Glomerular Filtration Rate" or "eGFR"
Heat Map
Correlating signs and symptoms with the kidney functions

1. cleanse the body of waste products or toxins- retention of creatinine, urea, uric acid
2. remove excess water, salt- retention of fluid in the lungs, heat, abdomen
high blood pressure
3. maintain electrolyte balance- sodium, potassium-- hyperkalemia-- arrhythmia
4. produce the hormone erythropoietin that helps in producing red blood cells--anemia,
easy faatigue
5. produce the hormone that converts Vit D to its active form- calcium
absorption---- weak bones
6. maintain acid base balance-- acidosis, abnormal breathing
Function of the Kidneys: Eryththropoietin Production and
Role in Red Blood Cell Production
THANK YOU FOR YOUR KIND ATTENTION
Other signs and symptoms of Chronic Kidney Disease
1.foamy urine
2.frequent urination
3.itchy or dry skin
4.nausea, loss of appetite
5.weight loss without trying to lose weight
6. late stages: easy fatigue, shortness of breath
7.pallor
8.trouble sleeping
9. breath smells like ammonia; " fishy breath"
 Goal: To slow the rate of GFR decline to delay
dialysis/transplant
Slower decline beginning later in life
100
90 • GFR declines over time
80
Moderate • Rate of decline varies by person
Kidney function: eGFR

70 decline
60
50
40
30 Fast decline
20
10

Kidney failure: dialysis/transplant

25 35 45 55 65 75
Age (years)
How can we slow down the progression of CKD
What can be done if a person already has CKD
1. Good control of Diabetes
2. Good control of blood pressure
3. Diet- depends on the stage of the disease
4. Avoid medications that damage the kidneys; do not self-medicate
5. Consult a doctor and go for regular check up
6. Know your risk factors
7. Medications - new drugs offer benefits
SGLT2 inhibitors- Dapaglifozin, Empaglifozin
Finerenone
GLP-1 agonists: Semaglutide
Schema of integrated effects of SGLT2 inhibitors likely to produce cardiovascular and renal benefits. SGLT2 inhibitors increase
natriuresis and glycosuria, resulting in various beneficial effects on the cardiovascular and renal systems. Together, these effects
preserve renal function and reduce the risk of heart failure decompensation and hospitalisation

SGLT2 inhibition

↑ Natriuresis and change in tissue sodium ↑ Glycosuria ↓ Plasma glucose

↓ AGE-
handling level
RAGE
and glucose toxicity
signalling
↓ Systemic (if hyperglycaemic)
↑ ↓ Plasma Improved
Tubuloglomerular volume and vascular ↓ Body mass and
blood visceral fat
feedback cardiac preload function
pressure
Glomerular afferent ↓ Plasma ↑ Ketone body
↑ Haematocrit production and
arteriolar vasoconstriction uric acid
level ketone metabolism
↓ Intraglomerular hypertension ↓ Inflammation
↓ Intraglomerular and oxidative
hyperfiltration stress

↓ Albuminuria ↓ Decline in ↓ Risk of heart failure decompensation and hospitalisation

eGFR

AGE, advanced glycation end product; CV, cardiovascular; eGFR, estimated glomerular filtration rate; RAGE, receptor for advanced glycation end products; SGLT2, sodium-glucose co-transporter-2
Cowie MR & Fisher M. Nat Rev Cardiol 2020;17:761
Christopher S. Wilcox. Hypertension. Antihypertensive and Renal
Mechanisms of SGLT2 (Sodium-Glucose Linked Transporter 2)
Inhibitors, Volume: 75, Issue: 4, Pages: 894-901, DOI:
(10.1161/HYPERTENSIONAHA.119.11684) © 2020 American Heart Association, Inc.
 SODIUM-GLUCOSE COTRANSPORTER 2 INHIBITORS

In terms of kidney protection and delaying kidney disease progression:

=work even in non-diabetics

=work even in later stages of kidney disease ( stage 4)

=work in patients with no albuminuria or low albumin in the urine

Effect on kidney disease progression/cardiovascular death

30

22.5
Absolute risk (%)

15

7.5

0
eGFR <30 eGFR 30-44 eGFR 45-90

Empagliflozin Placebo
 Annual rate of change of eGFR

Em
40

pa
Pl

gl
i fl
a ce

oz
bo

in
35
eGFR, mL/min/1.73m2
30

Chronic slope in mL/min/1.73m² per year

Placebo
Empagliflozin Mean (SE)
25

Mean (SE)

-1.37 (0.08) -2.75 (0.08)

0
2

12

18

24

30

36
M
o
 Sodium Glucose Cotransporter 2 Inhibitor
In chronic kidney disease, kidney function (eGFR) declines each year, at different rates
depending on various factors
• This may be around 1 unit of eGFR per year
• Or as fast as 5 units of eGFR per year in those progressing rapidly

SGLT2 Inhibitor Empagliflozin prevented loss of 1.4 units of eGFR per year
• Which means halting progression in those with slow progression
• And considerably delaying CKD progression-- increases the time to dialysis for those
patients with rapid progression
• Empagliflozin reduced the risk of hospital admission for any
cause
• Placebo group: 29.2 hospital admissions per 100 people/year
• If 100 people were treated with empagliflozin for 1 year,
there would be 4 fewer hospital admissions
 Kidney protective effects of SGLT2 inhibitors
could be mediated by different mechanisms 1

SGLT2 inhibitors increase distal

sodium delivery, thereby activating
Reduction in sodium and glucose tubuloglomerular feedback and
reabsorption induced by SGLT2 reducing hyperfiltration2
inhibitors reduces tubular
workload and could ameliorate
renal hypoxia, resulting in
improvements in tubular cell Glomerular afferent arteriolar
structural integrity and possibly vasoconstriction1
function2
Decreased intraglomerular
pressure 1,4,5
SGLT2 inhibitors have beneficial
effects on anti-inflammatory,
anti-oxidant and anti-fibrotic
markers2,3
This leads to:
✓ Decreased UACR1,5
(early clinical marker: eGFR dip)
✓ Decreased eGFR decline1

eGFR, estimated glomerular filtration rate; SGLT2, sodium-glucose co-transporter-2; UACR, urine albumin-to-creatinine ratio
1. Cowie MR and Fisher M Nat Rev Cariol 2020;17:761; 2. Dekkers CCJ et al. Curr Diab Rep 2018;18:27; 3. Sen T et al. Diabetes Obes Metab 2022, doi:
10.1111/dom.14779; 4. Thomas MC et al. Diabetologia 2018;61:2098; 4. Heerspink HJL et al. Kidney Int 2018;94:26; 5. Sugyama S et al. Intern Med
2018;57:2147
 SGLT2is and Renal Protection: From Biological Mechanisms to Clinical benefits

Mechanism of action Clinical Effect Renal Protection

Reduction in Intraglomerular pressure

Afferent vasoconstriction
GFR preservation
Glomerular Hyperfiltration

Neurohormonal Improvement
Intrarenal RAAS activity Blood pressure
SNS activity

Reduction in Inflammation/Fibrosis Tubular/Glomerular damage

Inflammation biomarkers
Albuminuria
Fibrosis biomarkers

Renal metabolism Hypoxia reduction Ischemic Renal damage

Solute transport Hemoglobin/ Hematocrit
Oxygen demand

Leoncini et. a. Int. J. Mol. Sci. 2021, 22(9), 4441; https://doi.org/10.3390/ijms22094441

 However, with multifactorial intervention, the
course of CKD has changed considerably
Incremental benefit of multifactorial intervention on GFR decline in patients with CKD and T2D

Severely decreased GFR

Kidney failure

This material is for educational purposes only with the intent to communicate the baseline characteristics and study design of EMPA-KIDNEY trial. Empagliflozin is not indicated
for the treatment of patients with chronic kidney disease in the Philippines. Please refer to the local approved product information for the current indication.
BP, blood pressure; CKD, chronic kidney disease; DKD, diabetic kidney disease; GFR, glomerular filtration rate; MRA, mineralocorticoid receptor antagonist; RAAS, renin–angiotensin–
aldosterone system; RRR, relative risk reduction; SGLT2, sodium-glucose co-transporter-2; T2D, type 2 diabetes
Fioretto P & Pontremoli R. Nat Rev Nephrol 2022;18:78
 SGLT2i renal benefits seen in CVOTs

EMPA-REG OUTCOME1 CANVAS Program2 DECLARE-TIMI 583 VERTIS CV4

(empagliflozin) (canagliflozin) (dapagliflozin) (ertugliflozin)

Serum creatinine doubling, Sustained ≥40% reduction in eGFR Kidney death,

Incident or to <60 ml/min/1.73 m2, ESKD or dialysis/transplant or doubling
worsening nephropathy* ESKD and death from
kidney causes kidney death of serum creatinine

39% 47% 47% 19%

p<0.001† NR‡ p<0.0001† n.s.

HR 0.61 HR 0.53 HR 0.53 HR 0.81

(95% CI 0.53, 0.70) (95% CI 0.33, 0.84) (95% CI 0.43, 0.66) (95% CI 0.63, 1.04)

Comparison of trials should be interpreted with caution due to differences in study design, populations and methodology

*Defined as progression to macroalbuminuria (UACR >300 mg/g), doubling of serum creatinine (accompanied by eGFR [MDRD] ≤45 ml/min/1.73 m2), initiation of RRT or
death from kidney disease; †Nominal p-value; ‡p‑value not reported in publication
CVOT, cardiovascular outcome trials; eCVD, established cardiovascular disease
See notes page for full list of abbreviations
1. Wanner C et al. N Engl J Med 2016;375:323; 2. Perkovic V et al. Lancet Diabetes Endocrinol 2018;6:691; 3. Mosenzon O et al. Lancet Diabetes Endocrinol 2019;7:606;
4. Cannon CP et al. N Engl J Med 2020; 383: 1425
RAASi was the standard of care for patients with CKD in the past 20 years to delay
CKD progression

Time to primary composite endpoint (doubling of serum creatinine, ESRD or death)

RENAAL (Losartan) IDNT (Irbesartan)

Risk reduction, 16% Risk reduction, 20%
P = 0.02 P = 0.02

Residual risk Residual risk

Huge Treatment Gap in Improving Outcomes of CKD

This material is for educational purposes only with the intent to communicate the EMPA-KIDNEY full trial results. Empagliflozin is not indicated for the treatment of patients
with chronic kidney disease in the Philippines. Please refer to the local approved product information for the current indication

Brenner B, et al. N Engl J Med 2001;345(12):861-869; Lewis EJ, et al. N Eng J Med 2001;345(12):851-860.
 GLP-1 agonists
=injectable drugs used to control blood sugar in
diabetes
=short acting: Exenatide, Liraglutide 1-2x a day
=Dulaglutide (Trulicity)- long acting once weekly injection
=can reduce appetite--control blood sugar, reduce
weight
=side effects: gastrointestinal
 all GLP-1 drugs can lead to weight loss

LIRAGLUTIDE: 10.5 to 15.8 pounds (4.8 to 7.2 kilograms) .

SEMAGLUTIDE and lifestyle changes: 33.7 pounds (15.3 kilograms)
MRA or Mineralocorticoid Receptor Agonist= Finerenone= another drug that
can help slow down kidney disease progression
= reduce inflammation and scarring in the kidneys and the heart
=approved for use in chronic kidney disease stage 4
HOW CAN WE PREVENT KIDNEY DISEASE?
1. Know your blood pressure
2. Know your blood sugar
3. Have a urine test- urinalysis, urine albumin creatinine ratio
4. Comply with medical instructions and prescriptions
5. Eat a healthy diet
6. Exercise regularly
7. Maintain ideal body weight
8 Do not take medications unless prescribed by a doctor; do not self-medicate
9. Know your risk factors:
Diabetes Mellitus, hypertension, heart disease/ heart failure
Family History of Kidney Failure, Obesity
Inherited disorders: Polycystic Kidney Disease
History of acute kidney injury
smoking or use of tobacco products, vaping
Avoid taking substances that may harm the kidneys:
energy drinks

In other words: Go for a medical check up

 CURRENT GAPS
UACR is underutilized as a baseline diagnostic tool
=albuminuria measurement is underutilized in practice. In the United States, less than
[3]

half of patients with T2D are screened for albuminuria yearly. [3]

=Real-world data show a globally low rate (35%) of albuminuria screening in patients with
T2D. When test yields positive result, what should be done?
[13]

A key rationale for CKD screening and staging is the growing availability of
treatments that are proven to delay CKD progression and reduce CV risk.[8] To use
treatments effectively, accurate diagnosis and staging of CKD are needed. Patient
engagement is also important in implementing screening and initiating treatment for
CKD.
 CKD Screening and Diagnosis for
Patients with Diabetes
single-voided “spot” urine samples is most convenient

(early morning sample is ideal)

(2021 CKD-EPI equation)

*ACR has marked variability hence, a confirmatory urine sample within 3–6 months is recommended2

1. KDIGO 2022 Clinical Practice Guideline on Diabetes Management in CKD. Kidney International. November 2022. 102;55:S1-S127
2. KDOQI clinical practice guidelines and recommendations for diabetes and CKD. Am J Kidney Dis. 2007;49(Suppl. 2):S12–S154
 What’s New in the KDIGO 2022 Clinical Practice Guidelines
in the Management of Diabetes with CKD?

COMPREHENSIVE CARE includes:

1. Lifestyle modification and self-management

2. First-line drugs (according to clinical

characteristics) with proven kidney and heart
protection
✓ combination of Metformin given until eGFR ≥30
ml/min/1.73m2) and SGLT2i’s initiated at eGFR
≥20 ml/min/1.73m2 and continued as tolerated,
until dialysis or transplantation is initiated
✓ Statin for all patients with diabetes and CKD
✓ RASi for patients with albuminuria and HTN

3. Additional drugs
✓GLP-1 RA is preferred if metformin+SGLT2i is
insufficient to meet glycemic targets
✓nsMRA can be added for T2D patients with
high CV and renal residual risk as evidenced by
persistent albuminuria >30mg/g
✓ASA for secondary prevention in eCVD or may
be considered for primary prevention in
KDIGO 2022 Clinical Practice Guideline on Diabetes Management in CKD. Kidney patients with high risk for ASCVD
International. November 2022. 102;55:S1-S127
 Holistic approach for improving outcomes in patients with diabetes and chronic
kidney disease
Consensus Report by ADA and KDIGO 2022 on Diabetes
Management in CKD

SGLT2i are recommended in

most patients with T2D and
CKD with eGFR ≥20
mL/min/1.73 m2 independent of
HbA1c or the need for
additional glucose lowering

Table 2: Considerations for selecting glucose-lowering

agents in patients with T2D and CKD
Progression of
ASCVD Heart Failure
CKD
Potential Potential
Metformin Neutral
benefit benefit
SGLT2
Benefita Benefitc Benefit
inhibitors

GLP-1 receptor Potential

Benefitb Benefitc
agonists benefit

*ACEi or ARB (at maximal tolerated doses) should be first-line therapy for hypertension when albuminuria is present. Otherwise, dihydropyridine calcium channel blocker or diuretic can also be
considered; all three classes are often needed to attain BP targets. †Finerenone is currently the only ns-MRA with proven clinical kidney and cardiovascular benefits
aBenefit supported by primary and secondary outcome data. bBenefit supported by secondary outcome data. cBenefit or risk is agent specific

T2D, type 2 diabetes; DM, Diabetes Mellitus; CKD, chronic kidney disease; KDIGO, kidney disease improving global outcomes
de Boer et.al., Diabetes Care. 2022;45(12):3075–3090
 ADA 2023 Standards of Medical Care includes several treatment options for
patients with T2D and comorbidities or at high risk for ASCVD
Goal: Cardiorenal Risk Reduction in High Risk Patients with T2D
To avoid therapeutic inertia reassess
ASCVD/indicators of high risk, CKD or HF and modify treatment regularly (3–6
months)

FIRST-LINE therapy choice depends on comorbidities, patient-centred treatment factors

(including cost and access considerations) and management needs;
generally includes metformin and comprehensive lifestyle modification*

+CKD §
Patients with ASCVD/indicators of Patients with HF Patients with CKD (on maximally
high risk tolerated dose of ACEi/ARB)
Preferably SGLT2i§
GLP-1 RA# either/
SGLT2i§ SGLT2i §
with primary evidence of reducing CKD progression
with proven CVD with proven CVD
or with proven Use SGLT2i in people with eGFR ≥20 mL/min/1.73m2;
benefit benefit
benefit in this once initiated, should be continued until initiation of
population dialysis or transplantation

If HbA1C above target or

GLP-1 RA
with proven CV benefit if SGLT2i not tolerated or
• For patients on a GLP-1 RA, consider adding
contraindicated
SGLT2i with proven CVD benefit or vice
versa 11.5a For people with T2D and DKD, use of SGLT2i is
• TZD ^ If A1c is above target, for patients on SGLT2i,
recommended to reduce CKD progression and CV
consider incorporating a GLP-1 RA or vice versa
events on patients with an eGFR ≥20
mL/min/1.73m2 and urinary albumin≥ 200 mg/g
Figure adapted from the American Diabetes Association. Diabetes Care 2023;46:S1. There are additional recommendations if HbA1ccreatinine (A)target; for full recommendations please refer to the
remains above
reference. *For adults who are overweight or with obesity, lifestyle modifications to achieve and maintain ≥5% weight loss 11.5b
and ≥150same text of
min/week but eGFR ≥20
moderate- mL/min/1.73physical
to vigorous-intensity m2 and activity is
recommended. Indicators of high risk (≥55 y/o with ≥2 risk factors including obesity, hypertension, smoking, dyslipidemia, or albuminuria);
urinary
§
For SGLT2i, CVD/renal
albumin rangingoutcomes trials demonstrate
from normal to 200 their efficacy
in reducing the risk of composite MACE, CV death, all-cause mortality, MI HHF, and renal outcomes in T2D individuals with eCVD. For GLP-1 RA, CVOTs demonstrate their efficacy in reducing the risk of
#

composite MACE, CV death, all-cause mortality, MI, HHF, and renal outcomes in T2D individual with eCVD or high risk eCVD. ^ Low-dose mg/gTZDcreatinine (B)tolerated and similarly effective
may be better
ADA, American Diabetes Association; ASCVD, atherosclerotic cardiovascular disease; CKD, chronic kidney disease; CV, cardiovascular; CVD, cardiovascular disease; CVOT, CV outcome trials; eGFR, estimated
glomerular filtration rate; GLP-1 RA, glucagon-like peptide-1 receptor agonist; HbA1c, glycated haemoglobin; HF, heart failure; LVH, left ventricular hypertrophy; SGLT2i, sodium-glucose co-transporter-2
inhibitor; T2D, type 2 diabetes
Standards of Care in Diabetes - 2023. Diabetes Care 2023;46(Suppl. 1):S140-S157
Frequently Asked Questions
1. Can kidney failure be reversed?
=it depends whether acute or chronic

2. Can CKD be reversed with medications?

=progression
once established ( disease is present for 3 months or more ) we can
only slow down the progression
Thank you for your kind Attention
 CURRENT GAPS
UACR is underutilized as a baseline diagnostic tool
=albuminuria measurement is underutilized in practice. In the United States, less than
[3]

half of patients with T2D are screened for albuminuria yearly. [3]

=Real-world data show a globally low rate (35%) of albuminuria screening in patients with
T2D. When test yields positive result, what should be done?
[13]

A key rationale for CKD screening and staging is the growing availability of
treatments that are proven to delay CKD progression and reduce CV risk.[8] To use
treatments effectively, accurate diagnosis and staging of CKD are needed. Patient
engagement is also important in implementing screening and initiating treatment for
CKD.