Managing hyperglycaemia in patients with diabetes and diabetic nephropathy–chronic kidney disease Summary of recommendations 2018

Peter Winocour, Stephen C Bain, Tahseen A Chowdhury, Parijat De, Ana Pokrajac, Damian Fogarty, Andrew Frankel, Debasish Banerjee, Mona Wahba, Indranil Dasgupta

Abstract


The ABCD Renal Association guidelines on managing hyperglycaemia in patients with diabetes and kidney disease (DM CKD) are evidence based with recommendations graded accordingly. Audit standards and areas for further research are proposed. Glycaemic targets should vary according to the type of diabetes and the stage of kidney disease. All anti-hyperglycaemic agents can be used in DM CKD but dosage will vary according to the degree of renal disease and certain therapies are currently contraindicated in advanced renal disease. Therefore surveillance for changes in renal function is vital to pre-emptive changes in therapy. Certain combination therapies are either inappropriate of illogical in DM CKD and all with DM CKD should be afforded Sick day Guidance to afford temporary withdrawal of certain therapies. Newer classes of anti-hyperglycaemic agents appear to have renal benefits independent of blood glucose lowering effects but these need clarification from additional studies with hard renal outcomes as primary end points, including evaluation in non–DM CKD.

Keywords


type 1 diabetes, insulin, chronic kidney disease, nephropathy, hypoglycaemia, sulfonylureas, metformin, sodium glucose co-transporter-2 (SGLT-2) inhibitors, pioglitazone, dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) analogue

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DOI: https://doi.org/10.15277/bjd.2018.172

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