Reducing the risk of progression of diabetic kidney disease

The risk of progression of diabetic kidney disease is reduced when a patient’s blood pressure and glycaemic profile are optimised. Management may include use of an angiotensin converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) in patients with albuminuria, and selection of antihyperglycaemic drugs that slow progression of diabetic kidney disease.

For patients with elevated blood pressure and any degree of albuminuria who have type 1 diabetes, use of a high-dose ACEI slows the progression of kidney disease.

For patients with elevated blood pressure and any degree of albuminuria who have type 2 diabetes, use of either a high-dose ACEI or ARB slows the progression of kidney disease.

See also Blood pressure reduction for patients with diabetes for advice on treating elevated blood pressure.

For patients without elevated blood pressure who have type 1 or type 2 diabetes and macroalbuminuria, treat with an ACEI or ARB.

For patients without elevated blood pressure who have type 1 or type 2 diabetes and microalbuminuria, treatment with an ACEI or ARB can be considered. Treatment reduces progression from microalbuminuria to macroalbuminuria and reduces risk of cardiovascular events but does not reduce progression to end-stage kidney disease. Weigh the harms and benefits of treatment, taking into account the patient’s age, eGFR, albuminuria stage and risk of hypotension.

For advice on using ACEIs and ARBs, see Angiotensin converting enzyme inhibitors to reduce blood pressure and Angiotensin II receptor blockers to reduce blood pressure.

For patients with type 2 diabetes and diabetic kidney disease, consider the use of antihyperglycaemic drugs with evidence of slowing progression of diabetic kidney disease, independent of their effect on the glycaemic profile (see Use of antihyperglycaemic drugs for cardiovascular and renal benefits in adults with type 2 diabetes).

For detailed information about managing chronic kidney disease, see the Kidney Health Australia website.