Treatment of Diabetic Nephropathy in Type 2 Diabetes Mellitus and Chronic Kidney Disease
When diabetic nephropathy develops in a patient who also has type 2 diabetes mellitus and chronic kidney disease, the coexistence of these conditions shapes both the treatment targets and the specific therapeutic options that evidence supports.
Clinical scenario
This protocol addresses patients with type 2 diabetes mellitus (T2DM) and coexisting chronic kidney disease (CKD). The combination carries distinct kidney and cardiovascular risk, and management must account for both diagnoses simultaneously.
Treatment approach
For patients already on maximally tolerated RAS inhibitor therapy, the evidence supports the addition of a nonsteroidal mineralocorticoid receptor antagonist with proven kidney and cardiovascular benefit — subject to specific criteria regarding kidney function, serum potassium, and albuminuria. The full eligibility thresholds and treatment algorithm are detailed in the complete protocol.
References
DOI: 10.1016/j.nefro.2024.11.002
- Patients with T2D and CKD with an eGFR ≥20 ml/min/1.73 m² should be treated with a sodium-glucose cotransporter-2 inhibitor and continue until end-stage kidney disease (dialysis or kidney transplant).
- We suggest a nonsteroidal mineralocorticoid receptor antagonist with proven kidney or cardiovascular benefit for patients with T2D, an eGFR ≥ 25 ml/min/1.73 m², normal serum potassium concentration (K ≤ 5.1 mmol/L), and albuminuria (uACR ≥ 30 mg/g) despite the maximum tolerated dose of RAS inhibitor.
- Finerenone is currently the only nonsteroidal MRA with proven clinical kidney and cardiovascular benefits.
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