Diabetic kidney disease, a main cause of end-stage kidney disease requiring renal replacement therapy, is associated with significant cardiovascular mortality. Reducing albuminuria confers cardiac and renal protection in the longer term.
- Albuminuria not only causes but also reflects structural damage to the kidneys.
- Albuminuria and a decline in glomerular filtration rate are key prognostic markers in diabetic kidney disease (DKD).
- Albuminuria is predictive not only of kidney function but also of cardiovascular risk and all-cause mortality.
- Clinical studies use reductions in the level of albuminuria as a surrogate marker of renoprotection.
- Current and future therapies for DKD aim to lower albuminuria and hence reduce the progression of kidney disease and minimise cardiovascular risk.
- The two main classes of drugs shown to confer renoprotection and cardioprotection in DKD are the renin-angiotensin-aldosterone system blockers and the sodium-glucose cotransporter-2 inhibitors.
- It is unclear whether aiming to lower albumin in the normoalbuminuric range translates to cost-effective benefit.