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Assessment of Vascular Function in Patients With Chronic Kidney Disease
08:50

Assessment of Vascular Function in Patients With Chronic Kidney Disease

Published on: June 16, 2014

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Cardiovascular Disease in Diabetes and Chronic Kidney Disease

Sowmya Swamy1, Sahibzadi Mahrukh Noor2, Roy O Mathew2,3

  • 1Department of Medicine, School of Medicine, George Washington University, Washington, DC 20052, USA.

Journal of Clinical Medicine
|November 25, 2023
PubMed

Insights

Managing diabetes mellitus (DM) and chronic kidney disease (CKD) is crucial for reducing cardiovascular disease (CVD) risk. Newer therapies like SGLT2 inhibitors and GLP1 receptor agonists show significant promise in improving outcomes for these patients.

Area of Science:

  • Nephrology
  • Cardiology
  • Endocrinology

Background:

  • Diabetic kidney disease (DKD) affects 40% of diabetes mellitus (DM) patients, significantly increasing cardiovascular disease (CVD) risk.
  • Chronic kidney disease (CKD) acts as a critical mediator of CVD risk in patients with DM.
  • Evidence shows higher CVD event rates in diabetic patients with CKD compared to those without.

Purpose of the Study:

  • To review current evidence on managing CKD in DM patients to mitigate CVD risk.
  • To highlight the role of glycemic control, renin-angiotensin system inhibition (RASI), SGLT2 inhibitors (SGLT2i), and GLP1 receptor agonists (GLP1RA) in DKD and CVD prevention.
  • To discuss the future directions in managing comorbid DM, CKD, and CVD.

Main Methods:

  • Review of multiple CVD outcomes trials and established evidence.
  • Analysis of the impact of blood pressure control, glycemic control, and RASI on CKD development and progression.
  • Evaluation of recent data on SGLT2i and GLP1RA in patients with and without CKD.

Main Results:

  • Glycemic control demonstrates the strongest evidence for preventing CKD development in DM.
  • RASI is effective in slowing CKD progression, particularly in cases with albuminuria.
  • SGLT2i and GLP1RA have shown significant reductions in mortality, heart failure hospitalizations, and CKD worsening in patients with DM, with or without existing CKD.

Conclusions:

  • Optimizing glycemic control is key for preventing CKD in diabetes.
  • RASI remains important for established CKD management.
  • SGLT2i and GLP1RA represent a paradigm shift, offering substantial benefits for cardiovascular and renal outcomes in patients with diabetes and CKD.
  • Future research focusing on combination therapies holds promise for further minimizing CVD events.

Keywords:
cardiovascular diseasechronic kidney diseasediabetes mellitusepidemiologysglt2 inhibitors

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