Evaluation and Treatment of Diabetic Kidney Disease

By Victoria Socha - May 31, 2023

Among patients with diabetes mellitus, diabetic kidney disease (DKD) is the leading cause of end-stage kidney disease (ESKD) and is associated with increased mortality risk.

During a poster session at the NKF Spring Clinical Meetings 2023, Prakash Gudsoorkar, MD, and colleagues reported results of an observational cohort study designed to examine the gaps in care in assessing and treating proteinuria in patients with DKD. The poster was titled Improving Care in Diabetic Kidney Disease: Bridging the Implementation Gap.

The study cohort included adults with a diagnosis of DKD (chronic kidney disease stage 1-5) being treated from January to December 2019 at a renal clinical at a tertiary academic health center. Exclusion criteria were type 1 diabetes mellitus, solid organ transplants, and ESKD.

The index visit was defined as the first available nephrology clinic visit. Eligible patients were assessed for DKD severity based on estimated glomerular filtration rate and proteinuria. Treatment conformity was evaluated based on the use of renin angiotensin system inhibitors (RASi), mineralocorticoid antagonists (MRA), and sodium-glucose cotransporter 2 inhibitors (SGLT2i). Clinical and laboratory data were extracted using informatics approaches; comparison across groups were examined with Chi-square tests.

The cohort included 1330 patients with available serum creatinine values. Of those, 70% had CKD stage 3 or better and 30% had CKD stage 4/5. Fifty-two percent were male, 54% were White, and 50% were 60 to 75 years of age. Medicare was the primary payer in 60% of the cohort. Fifty-four percent (711/1330) had proteinuria; among patients with CKD stage 4.5, 61% had proteinuria.

Verifiable prescription information was available for 69% of the cohort (917/1330). Of those patients, 72.% were on insulin. Eight percent were being treated with SGLT2 inhibitors, 76% with RAS inhibitors, and 22 % with MRA agents. Use of those agents was higher in the presence of proteinuria: SGLT2i 10% vs 6%, P=.018; RASi 81% vs 69%, P<.0001; and MRA 25% vs 19%, P=.0515.

Medication usage was lower among patients with CKD 4/5 compared with other CKD stages: SGLT2i 2% vs 11%, P<.0001; RASi 70% vs 78%, P=.0212; and MRA 18% vs 24%, P=.065.

In summary, the authors said, “By informatics-based approach we demonstrate needs assessment in the care of evaluation and treatment of DKD. Both proteinuria and CKD stage influenced usage of necessary therapies. Adoption of clinical pathways to narrow implementation gap in treatment of DKD will improve patient outcomes.”

Source: Gudsoorkar P, Piero N, Meganathan K, Campos-Naciff B, Thakar C. Improving care in diabetic kidney disease: bridging the implementation gap. Poster #279. Abstract of a poster presented at the National Kidney Foundation Spring Clinical Meetings 2023; April 11-15, 2023; Austin, Texas.

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