Are You Monitoring Diabetes Patients' Kidney Function?
Hello, my name is Per-Henrik Groop and I'm Professor of Nephrology at the University of Helsinki. At the moment I'm at the IDF Congress here in Dubai.
I have an important message to convey to you today: I think we doctors who treat patients with type 2 diabetes need to be aware of the prevalence of chronic kidney disease.
Chronic kidney disease in patients with type 2 diabetes is important because it has implications for the treatment we are using. Chronic kidney disease is defined as an estimated glomerular filtration rate (eGFR) below 60. If we add to that the possibility that the patient has an increased albumin-creatinine ratio, both are signs of kidney problems.
About 1 out of 2 patients with type 2 diabetes will have renal impairment, either reduced kidney function or an increased albumin excretion into the urine. This is important, especially with reduced kidney function. As I said, this has implications for treatment because most of the treatment modes we are using to lower blood glucose are problematic when the patient has chronic kidney disease. In fact, many of the available drugs have to be used in reduced doses if the patients have signs of chronic kidney disease.
In chronic kidney disease, an eGFR below 60 means that the patient has already lost quite a lot of kidney function. When we see that in our patients, then we need to think of how we can adjust their medications. Even insulin has to be used in reduced doses when the patient has kidney disease. Some sulfonylureas are contraindicated when we come down to low eGFR. Metformin is contraindicated, according to the US Food and Drug Administration and the European Medicines Agency guidelines, when we have an eGFR below 60, which is rather early. And even some of the new DPP-4 inhibitors have to be used in reduced doses when the kidneys are failing.
Given that 1 out of 2 patients will have renal impairment, many of them with reduced kidney function, we need to think about that when we are treating these patients. This is an important -- very important -- message that I would like all of you to think of when you are treating your patients.
The prevalence of hypoglycemia is much, much higher in patients with type 2 diabetes and chronic kidney disease. This complication is a feared one and can sometimes even be fatal.
So, the message I would like to convey to you is: Watch out for chronic kidney disease, measure the creatinine, and do the estimations of the eGFR. There are many, many wonderful formulas on the Web. Even your laboratory probably will provide you with the correct eGFR. Check that; if it's below 60, be aware that you may have to tailor the treatment differently. By doing that and making sure that you're using the available drugs in the right dosages, I think you are going to be very happy with the result for your patients. And patients will be very happy because you don't put them at risk for unnecessary complications that are related to the treatment. So, by that, I would like to say, watch out for chronic kidney disease. When you find it, take action.
Thank you for listening.
Hello, my name is Per-Henrik Groop and I'm Professor of Nephrology at the University of Helsinki. At the moment I'm at the IDF Congress here in Dubai.
I have an important message to convey to you today: I think we doctors who treat patients with type 2 diabetes need to be aware of the prevalence of chronic kidney disease.
Chronic kidney disease in patients with type 2 diabetes is important because it has implications for the treatment we are using. Chronic kidney disease is defined as an estimated glomerular filtration rate (eGFR) below 60. If we add to that the possibility that the patient has an increased albumin-creatinine ratio, both are signs of kidney problems.
About 1 out of 2 patients with type 2 diabetes will have renal impairment, either reduced kidney function or an increased albumin excretion into the urine. This is important, especially with reduced kidney function. As I said, this has implications for treatment because most of the treatment modes we are using to lower blood glucose are problematic when the patient has chronic kidney disease. In fact, many of the available drugs have to be used in reduced doses if the patients have signs of chronic kidney disease.
In chronic kidney disease, an eGFR below 60 means that the patient has already lost quite a lot of kidney function. When we see that in our patients, then we need to think of how we can adjust their medications. Even insulin has to be used in reduced doses when the patient has kidney disease. Some sulfonylureas are contraindicated when we come down to low eGFR. Metformin is contraindicated, according to the US Food and Drug Administration and the European Medicines Agency guidelines, when we have an eGFR below 60, which is rather early. And even some of the new DPP-4 inhibitors have to be used in reduced doses when the kidneys are failing.
Given that 1 out of 2 patients will have renal impairment, many of them with reduced kidney function, we need to think about that when we are treating these patients. This is an important -- very important -- message that I would like all of you to think of when you are treating your patients.
The prevalence of hypoglycemia is much, much higher in patients with type 2 diabetes and chronic kidney disease. This complication is a feared one and can sometimes even be fatal.
So, the message I would like to convey to you is: Watch out for chronic kidney disease, measure the creatinine, and do the estimations of the eGFR. There are many, many wonderful formulas on the Web. Even your laboratory probably will provide you with the correct eGFR. Check that; if it's below 60, be aware that you may have to tailor the treatment differently. By doing that and making sure that you're using the available drugs in the right dosages, I think you are going to be very happy with the result for your patients. And patients will be very happy because you don't put them at risk for unnecessary complications that are related to the treatment. So, by that, I would like to say, watch out for chronic kidney disease. When you find it, take action.
Thank you for listening.
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