Diabetic Kidney Disease Recommendations

2016 ADA Guideline Recommendations
Types of Diabetes Mellitus
Main Diabetes Page
Diabetes type I
Diabetes type II
Gestational Diabetes Mellitus
2016 ADA Standard of Medical Care Guideline Recommendations
Strategies for Improving Care
Classification and Diagnosis of Diabetes
Foundations of Care and Comprehensive Medical Evaluation Diabetes Self-Management, Education, and Support Nutritional Therapy
Prevention or Delay of Type II Diabetes
Glycemic Targets
Obesity Management for Treatment of Type II Diabetes
Approaches to Glycemic Treatment
Cardiovascular Disease and Risk Management Hypertension and Blood Pressure Control Lipid Management Antiplatelet Agents Coronary Heart Disease
Microvascular Complications and Foot Care Diabetic Kidney Disease Diabetic Retinopathy Diabetic Neuropathy Diabetic Footcare
Older Adults with Diabetes
Children and Adolescents with Diabetes Management of Cardiovascular Risk Factors in Children and Adolescents with Diabetes Microvascular Complications in Children and Adolescents with Diabetes
Management of Diabetes in Pregnancy
Diabetes Care in the Hospital Setting

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]; Seyedmahdi Pahlavani, M.D. [3]; Tarek Nafee, M.D. [4]

2016 ADA Standards of Medical Care in Diabetes Guidelines

Screening

"1. At least once a year, assess urinary albumin (e.g., spot urinary albumin–to– creatinine ratio) and estimated glomerular filtration rate in patients with type 1 diabetes with duration of $5 years, in all patients with type 2 diabetes, and in all patients with comorbid hypertension. (Level of Evidence: B)"

Treatment

"1. Optimize glucose control to reduce the risk or slow the progression of diabetic kidney disease. (Level of Evidence: A)"

"2. Optimize blood pressure control (,140/90 mmHg) to reduce the risk or slow the progression of diabetic kidney disease. (Level of Evidence: A)"

"3. For people with nondialysis-dependent diabetic kidney disease, dietary pro- tein intake should be 0.8 g/kg body weight per day (the recommended daily allowance). For patients on dialysis, higher levels of dietary protein intake should be considered. (Level of Evidence: A)"

"4. Either an ACE inhibitor or an angiotensin receptor blocker is recommended for the treatment of nonpregnant patients with diabetes and modestly elevated urinary albumin excretion (30–299 mg/day) B and is strongly recommended for those with urinary albumin excretion $300 mg/day and/or estimated glomerular filtration rate ,60 mL/min/1.73 m2. (Level of Evidence: A)"

"5. Periodically monitor serum creatinine and potassium levels for the develop- ment of increased creatinine or changes in potassium when ACE inhibitors, angiotensin receptor blockers, or diuretics are used. (Level of Evidence: E)"

"6. Continued monitoring of urinary albumin–to–creatinine ratio in patients with albuminuria treated with an ACE inhibitor or an angiotensin receptor blocker is reasonable to assess the response to treatment and progression of diabetic kidney disease. (Level of Evidence: E)"

"7. An ACE inhibitor or an angiotensin receptor blocker is not recommended for the primary prevention of diabetic kidney disease in patients with diabetes who have normal blood pressure, normal urinary albumin–to–creatinine ratio (,30 mg/g), and normal estimated glomerular filtration rate. (Level of Evidence: B)"

"8. When estimated glomerular filtration rate is ,60 mL/min/1.73 m2, evaluate and manage potential complications of chronic kidney disease. (Level of Evidence: E)"

"9. Patients should be referred for evaluation for renal replacement treatment if they have estimated glomerular filtration rate ,30 mL/min/1.73 m2. (Level of Evidence: A)"

"10. Promptly refer to a physician experienced in the care of kidney disease for uncertainty about the etiology of kidney disease, difficult management issues, and rapidly progressing kidney disease. (Level of Evidence: B)"