Effects of Renal Disease in the Management of Diabetics

In diabetic patients, the presence of one or more of cardiovascular disease (CVD) conditions such as myocardial infarction, heart failure, peripheral arterial disease, or coronary artery disease, increases their risk of developing renal compromise and eventual renal failure. Diabetic nephropathy is the most common cause of renal failure in the United States. Patients with diabetes and end stage renal disease (ESRD) have a very poor prognosis, and despite the availability of dialysis, most die prematurely of cardiovascular disease (DVD).

The most significant treatable risk factors for the development of renal failure among the diabetic population include uncontrolled hypertension, dyslipidemia, and poor glycemic control. Optimal management of patients with co-morbid diabetes and CVD requires a multi-factorial approach that requires a great deal of effort on the part of providers and their patients. The role for antihypertensive therapy in secondary prevention of CVD events is well established. Moreover, ACE inhibitors as well as angiotensin receptor blockers (ARBs) have been shown to be renoprotective in patients with hypertension and diabetes in a number of randomized controlled clinical trials. Dyslipidemia may aggravate renal disease in diabetic patients and the lipid profiles of patients with T2DM are generally characterized by a number of abnormalities, most often elevated triglyceride levels and low HDL cholesterol levels. There is ample evidence in favor of treating lipid abnormalities, usually with statins, in this population. For patients with diabetes, CVD, and renal compromise, diligent and consistent monitoring and appropriate interventions are required to delay progression of renal disease and to forestall cardiovascular and renal events.

In this conversation, two endocrinologists, Dr. Joseph Torre and Dr. Addison Taylor, join Dr. Carlos Hamilton, Jr. to discuss current issues surrounding the effects of renal disease in the management of diabetes.

Related References/Reading:

1. AACE Diabetes Mellitus Clinical Practice Guidelines Task Force. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of diabetes mellitus. Endocr Pract. 2007;13 Suppl 1:1-68.
2. Bakris GL, Ruilope L, Locatelli F, et al. Treatment of microalbuminuria in hypertensive subjects with elevated cardiovascular risk: Results of the IMPROVE trial. Kidney Int. 200772(7):879-85.
3. Fioretto P, Solini A. Antihypertensive treatment and multifactorial approach for renal protection in diabetes. J Am Soc Nephrol. 2005; 16: S18-S21.