In India, the burden of diabetic kidney disease is increasing rapidly due to the high and rising prevalence of type 2 diabetes mellitus. According to the Indian Council of Medical Research (ICMR), about 25-30% of people with diabetes in India develop some degree of kidney damage.
In an interview with HT Lifestyle, Dr Rajiv Kovil, Head of Diabetology at Zandra Healthcare and Co-Founder of Rang De Neela Initiative, claimed, “Early identification of kidney disease in diabetes is crucial to delay its progression to kidney failure and most people with kidney disease in diabetes eventually die of heart disease.”
He explained, “Podocytes are specialised cells in the kidney’s tissue, which is called the glomerular, which play a critical role in maintaining the filtration barrier. In T2DM, persistent hyperglycemia leads to podocyte injury, loss, and ultimately, resulting in protein leaking in urine . Podocyte loss is an early marker of diabetic kidney disease, often preceding a significant reduction in kidney function.”
Dr Rajiv Kovil elaborated, “The Urinary Albumin-to-Creatinine Ratio (UACR) is a key diagnostic marker that can detect early kidney damage. An elevated UACR (>30 mg/g) suggests albuminuria, which is indicative of early kidney disease. Early identification of elevated UACR enables timely therapeutic intervention to prevent progression to kidney failure.
Early treatment strategies
According to Dr Rajiv Kovil, early treatment strategies aimed at reducing UACR can significantly slow kidney disease progression –
- Patients with diabetic kidney disease often present with proliferative diabetic retinopathy (PDR) or diabetic macular edema (DME), and vice versa. Managing blood pressure, blood glucose, and kidney function concurrently can reduce the risk of retinopathy progression in diabetic patients with CKD.
- Sodium-glucose cotransporter-2 (SGLT2) inhibitors have emerged as a revolutionary class of drugs in managing both diabetes and CKD. SGLT2 inhibitors, such as empagliflozin, dapagliflozin, and canagliflozin, work by blocking glucose reabsorption in the kidneys, leading to glucose excretion and osmotic diuresis This mechanism results in reduced intraglomerular pressure, thereby protecting the kidneys from progressive damage.
Key benefits of SGLT2 inhibitors in CKD with diabetes:
1. Reduction in Albuminuria: Studies like the EMPA-KIDNEY and DAPA-CKD trials demonstrated significant reductions in albuminuria, thereby slowing CKD progression.
2. Preservation of Kidney Function: Long-term use of SGLT2 inhibitors reduces the decline in estimated glomerular filtration rate (eGFR).
3. Cardiovascular Protection: SGLT2 inhibitors also reduce cardiovascular events, a major cause of mortality in diabetic kidney disease.
4. Delaying Dialysis or Kidney Failure: By reducing intraglomerular pressure, SGLT2 inhibitors help delay the onset of ESRD.
Dr Rajiv Kovil asserted, “Chronic kidney disease remains a major complication of type 2 Diabetes, with significant morbidity and mortality. Early detection through UACR and managing proteinuria are essential strategies to slow kidney function decline.”
He concluded, “The advent of SGLT2 inhibitors has revolutionised the management of diabetic kidney disease by reducing albuminuria, preserving renal function and offering cardiovascular protection. As the burden of diabetes rises in India, widespread adoption of SGLT2 inhibitors, routine screening, and early intervention can substantially reduce the progression of CKD in diabetes, improving patient outcomes and quality of life.”
Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.