Diabetic kidney disease in the elderly: Diagnosis, treatment goals, and management

Current guidelines recommend screening patients with diabetes for diabetic kidney disease (DKD) using measurements of kidney damage (albuminuria) and function (estimated glomerular filtration rate [eGFR]) beginning 5 years after the diagnosis of type 1 diabetes mellitus (DM) or at the time of diagnosis of type 2 DM, and then annually there after. Early intervention in patients with chronic kidney disease (CKD) - especially those with DKD - is important, not only to delay the development of endstage renal disease (ESRD) and the need for renal replacement therapy, but also to decrease mortality. One of the main treatment strategies for DKD is to decrease albuminuria through inhibition of the reninangiotensinaldosterone system. The use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers has become the standard of care for the treatment of DKD; however, although these drugs slow progression to ESRD, they are not curative, nor are they necessarily preventative once estab lished diabetic nephropathy is present. Control of other confounding conditions, including blood pressure, lipids, and hyperglycemia, is also important in optimizing patient care.