Diabetes and the kidney

Module 4: Monitoring and follow up

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CME Credits: 1
Module duration: 1 hour
Launch date: Spring 2020 (version 1)
Updated: Spring 2023 (version 2)
Expiry date: March 2027
Audience: Diabetes and Metabolism Specialists (Subspeciality), Endocrinologists (Subspeciality), General Physicians (Advanced), Nephrologists (Subspeciality)

My name is Sally Marshall. I am Professor of Diabetes at Newcastle University and Editor-in-Chief of Diabetologia, the journal of the EASD. Despite our best efforts, kidney disease does sadly still progress in a significant proportion of people with diabetes. In this module, we will look at the importance of measuring urine albumin excretion and estimated glomerular filtration rate (eGFR) on a regular basis to monitor the decline in kidney function. These parameters can also be used as a measure of success, or otherwise, of our interventions - including blood pressure control. As GFR declines, the kidney’s handling of glucose and of glucose-lowering agents alters and hypoglycaemia becomes an increasing risk. We will look at factors around this. We will also look at some of the other abnormalities that develop as kidney disease progresses, including renal anaemia.

Good glycaemic control and normotension are the cornerstones of both prevention and management of diabetic kidney disease (DKD). In order to detect the progression of DKD, ongoing monitoring of albuminuria and glomerular filtration rate (GFR) should be performed on a regular basis. As the disease progresses and renal function declines, the dose and appropriateness of glucose-lowering medications should be considered, in particular due to the increased risk of hypoglycaemia. Anaemia is an important complication of DKD because it contributes significantly to the heavy symptom burden. This module is designed to help you understand what to consider in the monitoring and follow-up of people with diabetes and those with DKD.

Doria A, Galecki AT, Spino C, Pop-Busui R, Cherney DZ, Lingvay I, Parsa A, Rossing P, Sigal R, Afkarian M, Aronson R, Luiza Caramori M, Crandall J, de Boer I, Elliott T, Goldfine A, Haw J, Hirsch I, Karger A, Maahs D, McGill J, Molitch M, Perkins P, Polsky S, Pragnell M, Robiner W, Rosas S, Senior P, Tuttle K, Umpierrez G, Wallia A, Weinstock R, Wu C, Mauer M, for the PERL Study Group (2020). Serum Urate Lowering with Allopurinol and Kidney Function in Type 1 Diabetes. N Engl J Med 2020; 382:2493-2503.
http://www.nejm.org/doi/full/10.1056/NEJMoa1916624

Learning Outcomes

By the end of this module, you will be able to:

Explain the process for the ongoing monitoring of kidney function, blood glucose and anaemia in people with diabetic kidney disease, including the limitations of monitoring

Explain how to optimise pharmacological management of hyperglycaemia, particularly as renal function declines and the risk of severe hypoglycaemia increases

Identify novel biomarkers that have the potential to diagnose and stratify risk of CKD in patients with diabetes


This module includes self-marked assessments, such as knowledge checks and/or case studies, as well as a marked final assessment, which you can attempt up to five times. To complete the module, you must review all chapters, pass the final assessment (80% pass mark), and fill in our feedback form.


Contributors

Professor
Sally Marshall
Author
Professor
Per-Henrik Groop
Expert Reviewer
Assessment Setter
Assessment Setter