Diabetic Kidney Disease: A Report From an ADA Consensus

Diabetes Care 2014;37:2864–2883 | DOI: 10.2337/dc14-1296The incidence and prevalence of diabetes mellitus have grown significantlythroughout the world, due primarily to the increase in type 2 diabetes. This overallincrease in the number of people with diabetes has had a major impact ondevelopment of diabetic kidney disease (DKD), one of the most frequentcomplicationsofbothtypesofdiabetes.DKDistheleadingcauseofend-stagerenaldisease (ESRD), accounting for approximately 50% of cases in the developed world.AlthoughincidenceratesforESRDattributabletoDKDhaverecentlystabilized,theserates continue to rise in high-risk groups such as middle-aged African Americans,Native Americans, and Hispanics. The costs of care for people with DKD areextraordinarily high. In the Medicare population alone, DKD-related expendituresamong this mostly older group were nearly $25 billion in 2011. Due to the highhumanandsocietalcosts,theConsensusConferenceonChronicKidneyDiseaseandDiabetes wasconvened bytheAmericanDiabetes Associationincollaboration withtheAmericanSocietyofNephrologyandtheNationalKidneyFoundationtoappraiseissues regarding patient management, highlighting current practices and newdirections. Major topic areas in DKD included 1)identification and monitoring, 2)cardiovascular disease and management of dyslipidemia, 3)hypertensionanduseofrenin-angiotensin-aldosteronesystemblockadeandmineralocorticoidreceptorblock-ade, 4) glycemia measurement, hypoglycemia, and drug therapies, 5) nutrition andgeneral care in advanced-stage chronic kidney disease, 6) children and adolescents,and7)multidisciplinaryapproachesandmedicalhomemodelsforhealthcaredelivery.This current state summary and research recommendations are designed to guideadvancesincareandthegenerationofnewknowledgethatwillmeaningfullyimprovelife for people with DKD.