eGFR Slope, CKD Progression, and Pillars of Care in Patients With Diabetic Kidney Disease

What is it about?

Chronic kidney disease (CKD) is a long-term condition in which the kidneys gradually lose their ability to filter wastes and extra fluid from the blood. It affects around 1 in 7 adults in the United States and over 800 million people worldwide. Early detection and treatment are crucial because kidney disease often shows no symptoms until it has advanced so many people do not realize they have CKD until it is at a more advanced stage. A leading cause of CKD is diabetes, a widespread illness in which high blood sugar levels can damage the tiny blood vessels in the kidneys. High blood pressure (hypertension) also contributes to kidney damage by increasing pressure within these blood vessels, causing them to deteriorate over time. Clinicians use an important test called the estimated glomerular filtration rate (eGFR) to measure how well the kidneys are working. They track how this rate changes, known as the “eGFR slope,” to identify signs of worsening kidney function. Regular testing for albumin (a type of protein) in the urine can help detect kidney damage early, prompting timely treatment. Several new therapies are now available to slow CKD progression in people with diabetes (also referred to as diabetic kidney disease or DKD). These treatments work in different ways to lower blood pressure within the kidneys, control blood sugar levels, and reduce the harmful processes that lead to inflammation and scarring. One group of drugs called SGLT2 inhibitors not only helps remove excess sugar through the urine but also lowers harmful pressures in the kidney’s filtering units. Another class of medication known as non-steroidal mineralocorticoid receptor antagonists, finerenone, reduces inflammation and scar formation in the kidneys. Yet another type of therapy, the GLP-1 receptor agonists, can help control blood sugar and support healthy body weight, while also protecting kidney function. When used in combination with standard treatments such as blood pressure medications known as ACE inhibitors or ARBs, these therapies can slow the decline in kidney function. They may also reduce the need for dialysis and protect against life-threatening conditions like heart disease. By testing the eGFR and urine albumin levels regularly, healthcare providers can see whether these treatments are effectively slowing down the damage to the kidneys, and they can make changes as needed. This approach, known as a multi-targeted or a combination therapy plan, aims to keep the kidneys healthy for longer and reduce the risks associated with diabetic kidney disease.

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Photo by Robina Weermeijer on Unsplash

Photo by Robina Weermeijer on Unsplash