Doms № 4 -2022

Modern possibilities of effective nephroprotection in patients with diabetes

Cherenko M. S.


Chronic kidney disease is a term proposed back in 2002, which most accurately reflects the process of stable (more than 3 months) kidney damage. This is confirmed by laboratory indicators in blood and urine, as well as changes in the kidneys according to the results of ultrasound and biopsies. The most reliable indicator of the decrease in kidney function is a decrease in the hunch index of glomerular filtration rate below 60 ml/min/173 m2. The most common causes of chronic kidney disease are diabetes, arterial hypertension and cardiovascular diseases. Due to the growing prevalence of these diseases, the frequency of kidney damage also increases. Unfortunately, despite the fact that groups of patients at risk and possible causes of chronic kidney disease are known, very often this pathology is detected in late stages. Today, in the world more than 800 million people suffer from chronic kidney disease and diagnosis of chronic kidney disease often is made only at 4–5 stages. Among the main risk factors of the progression of chronic kidney disease is hyperglycemia, hypertension and obesity. In the article the risk factors of chronic kidney disease are discussed along with approach to modern treatment.

Key words: chronic kidney disease, treatment, risk factors, kidney function.

  1. Alicic R.Z., Rooney M.T., Tuttle K.R. Diabetic kidney disease: challenges, progress, and possibilities // Clin J Am Soc Nephrol 12: 2032–2045, 2017. doi:
  2. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017 // Lancet. 2018. Vol. 392. № 10159. P. 1789–1858.
  3. Wong L.Y., Liew A.S.T., Weng W.T. et al. Projecting the burden of chronic kidney disease in a developed country and its implications on public health // Int. J. Nephrol. 2018. № 2018. ID 5196285.
  4. Hill N.R., Fatoba S.T., Oke J.L. et al. Global prevalence of chronic kidney disease – a systematic review and meta-analysis // PLoS One. 2016. Vol. 1. № 7. P. e0158765.
  5. Wheeler D.C., Stefánsson B.V., Jongs et al. Effects of dapagliflozin on major adverse kidney and cardiovascular events in patients with diabetic and non-diabetic chronic kidney disease: a prespecified analysis from the DAPA-CKD trial // Lancet Diabetes Endocrinol 2021; 9: 22–31.
  6. Xie Y., Bowe B., Mokdad A.H. et al. Analysis of the Global Burden of Disease study highlights the global, regional, and national trends of chronic kidney disease epidemiology from 1990 to 2016 // Kidney Int. 2018. Vol. 94. № 3. P. 567–581.
  7. Zelnick L.R., Weiss N.S., Kestenbaum B.R. et al. Diabetes and CKD in the United States population, 2009–2014 // Clin. J. Am. Soc. Nephrol. 2017. Vol. 12. № 12. P. 1984–1990.
  8. Szczech L.A., Stewart R.C., Su H.-L. et al. Primary care detection of chronic kidney disease in adults with type-2 diabetes: the ADD-CKD Study (awareness, detection and drug therapy in type 2 diabetes and chronic kidney disease) // PLoS One. 2014. Vol. 9. № 11. P. e110535.
  9. Fraser S.D., Blakeman T. Chronic kidney disease: identification and management in primary care // Pragmat. Obs. Res. 2016. Vol. 7. P. 21–32.
  10. Cravedi P., Remuzzi G. Pathophysiology of proteinuria and its value as an outcome measure in chronic kidney disease // Br. J. Clin. Pharmacol. 2013. Vol. 76. № 4. P. 516–523.
  11. Spijkerman A.M., Dekker J.M., Nijpels G. et al. Microvascular complications at time of diagnosis of type 2 diabetes are similar among diabetic patients detected by targeted screening and patients newly diagnosed in general practice: the hoorn screening study // Diabetes Care. 2003. Vol. 26. № 9. P. 2604–2608.
  12. Harris M.I., Klein R., Welborn T.A., Knuiman M.W. Onset of NIDDM occurs at least 4–7 yr before clinical diagnosis // Diabetes Care. 1992. Vol. 15. № 7. P. 815–819.
  13. Matsushita K., Coresh J., Sang Y. et al. Estimated glomerular filtration rate and albuminuria for prediction of cardiovascular outcomes: a collaborative meta-analysis of individual participant data // Lancet Diabetes Endocrinol. 2015. Vol. 3. № 7. P. 514–525.
  14. Fox C.S., Matsushita K., Woodward M. et al. Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis // Lancet. 2012. Vol. 380. № 9854. P. 1662–1673
  15. George L.K., Koshy S.K.G., Molnar M.Z. et al. Heart failure increases the risk of adverse renal outcomes in patients with normal kidney function // Circ. Heart. Fail. 2017. Vol. 10. № 8. P. e003825.
  16. Schefold J.C., Filippatos G., Hasenfuss G. et al. Heart failure and kidney dysfunction: epidemiology, mechanisms and management // Nat. Rev. Nephrol. 2016. Vol. 12. № 10. P. 610–623.
  17. Chan G.C., Tang S.C. Diabetic nephropathy: landmark clinical trials and tribulations // Nephrol. Dial. Transplant. 2016. Vol. 31. № 3. P. 359–368.
  18. Wiviott S.D., Raz I., Bonaca M.P. et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes // N. Engl. J. Med. 2019. Vol. 380. № 4. P. 347–357.
  19. Zinman B., Wanner C., Lachin J.M. et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes // N. Engl. J. Med. 2015. Vol. 373. № 22. P. 2117–2128.
  20. Cosentino F., Cannon C.P., Cherney D.Z. et al. Efficacy of ertugliflozin on heart failure-related events in patients with type 2 diabetes mellitus and established atherosclerotic cardiovascular disease: results of the VERTIS CV trial // Circulation. 2020. Vol. 142. № 23. P. 2205–2215.
  21. Mosenzon O., Wiviott S.D., Cahn A. et al. Effects of dapagliflozin on development and progression of kidney disease in patients with type 2 diabetes: an analysis from the DECLARE-TIMI 58 randomised trial // Lancet Diabetes Endocrinol. 2019. Vol. 7. № 8. P. 606–617.
  22. Heerspink H.J.L., Stefánsson B.V., Correa-Rotter R. et al. Dapagliflozin in patients with chronic kidney disease // N. Engl. J. Med. 2020. Vol. 383. № 15. P. 1436–1446.
  23. American Diabetes Association. Standards of Medical Care in Diabetes – 2021 // Diabetes Care. 2021. Vol. 44. Suppl. 1.
  24. Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease // Kidney Int. 2020. Vol. 98. № 4S. P. S1–S115
  25. Nathan DM; DCCT/EDIC Research Group: The diabetes control and complications trial/epidemiology of diabetes interventions and complications study at 30 years: Overview.Diabetes Care 37: 9–16, 201
  26. DCCT/EDIC Research Group; de Boer IH, Sun W, Cleary PA, Lachin JM, Molitch ME, Steffes MW, Zinman B: Intensive diabetes therapy and glomerular filtration rate in type 1 diabetes. N Engl J Med 365: 2366–2376, 2011
  27. Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HAW: 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 359: 1577–1589, 2008