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Time of India
26-05-2025
- Health
- Time of India
How can people with diabetes effectively prevent kidney disease?
Kidney disease affects more than one third of people with diabetes and is the most common cause of renal failure on a global scale. People with diabetes can get kidney disease as result of poor control of glucose levels or other secondary causes like infections, autoimmune diseases, harmful medications etc. Preventing diabetic kidney disease needs a proactive approach with optimal management of lifestyle, medications to control the risk factors, and regular screening. Lifestyle changes are key in control of the metabolic risk factors for the kidney disease. Portion control of carbohydrates with increasing the vegetables, and lean proteins is important for good glycemic control. Eliminate simple carbs and processed sugars. Salt restriction is necessary for control of hypertension. A physical activity schedule involving aerobic and resistance training with at least 150 minutes of moderate activity is necessary. Weight loss of even 5% can improve the insulin sensitivity and reduce the blood pressure. Adequate hydration is important for renal health. People with diabetes are at a higher risk for urinary infections. It is important to screen and treat the urinary infections promptly as ascending infections often cause renal dysfunction. Especially people with additional risk factors like urinary stones, phimosis, and urethral strictures etc. need to be extra cautious. Medications such as NSAIDs, antifungals, and antibiotics which can potentially lead to renal injury should be used cautiously under medical supervision. When choosing the medications in patients with diabetes, the risk for kidney disease needs to be considered. We have medications like SGLT2 inhibitors, and GLP1 receptor agonists which can reduce the progression of kidney damage independent of the glucose control they provide. For patients with early signs of renal damage like proteinuria, these medications can delay and potentially prevent the onset of kidney disease. In addition, we need to control the cholesterol levels to optimal targets for reduction of cardiovascular events in addition to renal protection. Medications used for control of blood pressure like ACE inhibitors and ARBs also reduce the proteinuria and help in prevention of progression of the kidney disease. We have a new class of medications called non-steroidal MR blockers e.g. Finerenone which also reduce the proteinuria and prevent kidney disease progression. With the help of lifestyle measures and appropriate medications, we should target optimal glucose levels with Hba1c <7% for most adults and to keep the blood pressure < 130/80 mm Hg. Regular screening for kidney disease helps in early detection. Annual screening for proteinuria (using urine albumin to creatinine ratio) and estimated glomerular filtration rate (calculated based on serum creatinine level) is imperative for people with type 2 diabetes. Timing of the intervention plays an important role in prevention of kidney damage. Educating the patients about complication screening during clinic visits for diabetes helps a lot. At a community level educating the public with collaboration of dieticians, primary care physicians, endocrinologists, and nephrologists is imperative in spreading the awareness. Promoting widespread access to screening tests boosts efforts in early diagnosis and prevention. We need to think of primordial prevention. Identifying the people with metabolic risk factors, and preventing diabetes, and hypertension through lifestyle measures will have a greater impact than interventions at a later stage. To summarize, prevention diabetic kidney disease revolves around improvement of lifestyle, optimization of the metabolic risk factors through medications, and regular screening to diagnosed the kidney disease in a very early stage. With early diagnosis and optimal management, we can preserve the renal health and improve the quality of life for people with diabetes. Dr. Varun Suryadevara, Endocrinologist, MBBS MD Internal Medicine DM Endocrinology, Apollo Hospitals, Bangalore One step to a healthier you—join Times Health+ Yoga and feel the change
Yahoo
30-04-2025
- Health
- Yahoo
Finerenone continues to impress in diabetic kidney disease
In a recent study conducted by Sankar D Navaneethan and colleagues and published in the International Society of Nephrology, the cardiovascular and kidney benefits of Bayer's Kerendia (finerenone) are maintained regardless of acute changes in estimated glomerular filtration rate (eGFR) following treatment initiation in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D). Leading data and analytics company GlobalData believes that this comprehensive analysis will reassure nephrologists about prescribing finerenone to patients with CKD and T2D, even if initial eGFR declines are observed. The consistent efficacy across eGFR change subgroups, combined with a manageable safety profile, supports the use of finerenone as an important therapeutic option for this high-risk patient population. Finerenone is a nonsteroidal mineralocorticoid receptor antagonist (MRA). Compared to steroidal MRAs, finerenone has a shorter half-life and a more balanced distribution between the heart and the kidney. The study included an analysis of the prespecified FIDELITY trial, a pooled individual-level analysis of two major Phase III clinical trials: FIDELIO-DKD and FIGARO-DKD. This new analysis addressed an important clinical concern, specifically the hesitancy to prescribe or continue medications associated with acute eGFR decline. The study demonstrated that finerenone consistently reduced composite cardiovascular outcomes across all eGFR change subgroups, with hazard ratios of 0.74 (95% confidence interval 0.61-0.90) for patients with more than 10% eGFR decline, 0.87 (0.73-1.04) for >0-10% eGFR decline, 1.06 (0.87-1.28) for 0-10% eGFR increase, and 0.78 (0.61-0.99) for more than 10% eGFR increase. While there was a numeric interaction (p=0.048), the interaction was not significant (p=0.58) when modelled as a continuous variable. Similarly, finerenone reduced composite kidney outcomes across all eGFR change categories, with hazard ratios of 0.67 (0.53-0.85) for more than 10% eGFR decline, 0.78 (0.61-1.01) for >0-10% eGFR decline, 0.56 (0.40-0.77) for 0-10% eGFR increase, and 0.75 (0.50-1.14) for more than 10% eGFR increase. The interaction was not significant (p=0.23 for categories, p=0.36 for continuous modelling). These findings provide reassurance for nephrologists who may be hesitant to prescribe medications associated with initial eGFR reductions. Kerendia received US Food and Drug Administration approval in July 2021 to reduce the risk of sustained eGFR decline, end-stage kidney disease, cardiovascular death, nonfatal myocardial infarction, and hospitalisation for heart failure in adults with CKD associated with T2D. "Finerenone continues to impress in diabetic kidney disease" was originally created and published by Clinical Trials Arena, a GlobalData owned brand. The information on this site has been included in good faith for general informational purposes only. It is not intended to amount to advice on which you should rely, and we give no representation, warranty or guarantee, whether express or implied as to its accuracy or completeness. You must obtain professional or specialist advice before taking, or refraining from, any action on the basis of the content on our site. Sign in to access your portfolio
