Recommendations: Nephropathy Treatment (2)

Recommendations for the treatment of nephropathy in patients with diabetes1 are summarized in three slides Slide 2 of 3 When ACE inhibitors, ARBs, or diuretics are used, monitor serum creatinine and potassium levels for the development of increased creatinine (E) Continued monitoring of urine albumin excretion to assess both response to therapy and progression of disease is reasonable (E) When estimated GFR is <60 mL/min/1.73 m2, evaluate and manage potential complications of CKD (E) ACE inhibitors have been shown to reduce major CVD outcomes (i.e., MI, stroke, death) in patients with diabetes,2 thus further supporting the use of these agents in patients with albuminuria, a CVD risk factor ARBs do not prevent onset of albuminuria in normotensive patients with type 1 or type 2 diabetes;3 however, ARBs have been shown to reduce the rate of progression from micro- to macroalbuminuria as well as ESRD in patients with type 2 diabetes490References American Diabetes Association. Standards of medical care in diabetes—2013. Diabetes Care 2013;36(suppl 1):S35. Heart Outcomes Prevention Evaluation Study Investigators. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet 2000; 355:253-259. Mauer M, Zinman B, Gardiner R, et al. Renal and retinal effects of enalapril and losartan in type 1 diabetes. N Engl J Med 2009;361:40-51. Lewis EJ, Hunsicker LG, Clarke WR, et al.; Collaborative Study Group. Renoprotective effect of the angiotensin receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 2001;345:851-860.