Treatment of Chronic Kidney Disease with Type 2 Diabetes and Albuminuria
Patients with chronic kidney disease (CKD) who also have type 2 diabetes and a moderately-to-severely increased urine albumin-to-creatinine ratio (uACR >30 mg/g) represent a distinct high-risk group that calls for a specific, evidence-based treatment strategy beyond standard CKD care.
Clinical Scenario
CKD co-existing with type 2 diabetes and albuminuria — uACR above 30 mg/g (moderately-to-severely increased). This combination carries significant risk of progression and requires targeted intervention guided by the latest evidence.
Treatment Approach — partial overview
The structured protocol for this scenario includes the addition of a specific class of long-acting injectable or oral therapy with established cardiovascular evidence, selected over alternatives on the basis of outcome data.
Full regimen — drug class, agent selection criteria, sequencing, and monitoring targets — is available via the structured protocol below →
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).
- In adults with T2D and CKD who have not achieved individualized glycemic targets despite use of metformin and SGLT2 inhibitor treatment, or who are unable to use those medications, we recommend a long-acting GLP-1 RA (1B).
- The choice of GLP-1 RA should prioritize agents with documented cardiovascular benefits.
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