Challenges in the Prevention and Management of Diabetic Kidney Diseases

Diabetic kidney disease (DKD) is one of the common complications of diabetes mellitus, which substantially decreases the quality of life and increases the risk of premature mortality (1). Although it is the most common cause of end-stage renal disease (ESRD) (2), the mortality is mostly due to cardiovascular diseases and therefore DKD is regarded as a major cardiovascular risk factor (3, 4). Due to its chronic and slowly progressing nature, DKD is generally diagnosed by screening tests showing albuminuria or low eGFR, or both in subjects with diabetes. Up to one-third of patients with type 1 diabetes (T1DM) (5–7)and nearly half of patients with type 2 diabetes (T2DM) have DKD (6, 8–10). Yet, fewer of them receive optimal care to prevent DKD progression and avoid the cardiovascular and renal endpoints (11).