Major Risks Indicators for Diabetic Kidney Disease

Abstract

Risks for diabetic kidney disease have traditionally focused on those associated with loss of renal function, particularly glomerular filtration rate (GFR). The ultimate consequence of GFR loss, end-stage renal disease (ESRD), has long been the primary domain for many nephrologists. However, loss of renal function also encompasses many aspects other than GFR. A number of comorbidities result from, or are exacerbated by, damage to the kidney: hypertension, anemia, disordered bone and mineral metabolism, dyslipidemia, and inflammation, among others. Many of these disturbances are more prevalent, occur earlier, and are more severe in diabetes than in other forms of chronic kidney disease (CKD) (1–4). Furthermore, they may contribute to further kidney damage, as well as to cardiovascular disease (CVD). The latter issue is of particular concern because most people with diabetes who develop CKD will die of CVD rather than reach ESRD (5). Therefore, kidney damage and associated comorbidities can be viewed as fundamental participants in a self-perpetuating, positive feedback cycle that produces widespread injury to the circulation with multiple target organ consequences. Because diabetes and CKD pose such a high risk of mortality and major adverse events, the purpose of this chapter is to review major risks indicators. Identification of risks allows for development of improved strategies for detection, intervention, and novel therapeutic approaches.