Treatment of Chronic Kidney Disease in Type 2 Diabetes with Albuminuria
Clinical Scenario
Type 2 DiabetesPatients with chronic kidney disease (CKD) who have type 2 diabetes and moderately-to-severely increased albuminuria — urine albumin-to-creatinine ratio (UACR) greater than 30 mg/g (A2 or A3 category) — represent a high-risk subgroup that warrants a specific, evidence-based treatment approach across CKD stages G1 through G4.
Treatment Approach
In this population, management centres on renin-angiotensin-system (RAS) inhibition — a class of agents with guideline-recommended use in this specific combination of CKD, type 2 diabetes, and albuminuria. The full treatment algorithm, agent selection, dosing strategy, and monitoring parameters are detailed in the complete protocol.
References
DOI: 10.1016/j.kint.2023.10.018
We recommend starting RASi (ACEi or ARB) for people with CKD and moderately-to-severely increased albuminuria (G1–G4, A2 and A3) with diabetes (1B).
RASi (ACEi or ARB) should be administered using the highest approved dose that is tolerated to achieve the benefits described because the proven benefits were achieved in trials using these doses.
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