Diabetic nephropathy
Chronic kidney disease in patients with type 1 or type 2 diabetes: albuminuria, reduced eGFR. Foundational therapy per KDIGO 2022: ACE inhibitor or ARB at the maximally tolerated dose, plus SGLT2 inhibitor.
ICD-10 N08.32 drugs
Also known as: Diabetic kidney disease, DKD
Drugs used for this condition
- ACaptoprilFirst line · ACE inhibitorACE inhibitors slow the progression of diabetic nephropathy in patients with type 1 diabetes and albuminuria, as shown in the Lewis trial (1993) of captopril 75 mg daily: 48 percent reduction in creatinine doubling. KDIGO 2022 recommends ACE inhibitors or ARBs at the maximally tolerated dose in patients with diabetes and A2–A3 albuminuria. In current practice captopril has been displaced by lisinopril and ramipril, which are dosed once daily.
- BCandesartanFirst line · Angiotensin II receptor blockerARBs slow the progression of diabetic nephropathy in patients with type 2 diabetes and albuminuria. Pivotal trials are RENAAL (losartan) and IDNT (irbesartan). The DIRECT-Protect 2 trial with candesartan showed a reduction in the progression rate from microalbuminuria to nephropathy. KDIGO 2022 lists ARBs as first-choice agents in patients with albuminuria alongside ACE inhibitors.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit