Current understanding of the phenotypes of chronic kidney disease in patients with diabetes mellitus
https://doi.org/10.62751/2713-0177-2025-6-1-08
Abstract
Chronic kidney disease (CKD) is one of the most common complications of type 2 diabetes mellitus. Currently, in addition to the classic CKD phenotype, three alternative phenotypes of CKD in diabetes are known, which are characterized by regression of albuminuria, a rapid decrease in SCF or “non-albuminuric” CKD. Inflammatory and fibrotic lesions of various structures in the kidneys due to diabetes determine the multiplicity and unpredictability of the trajectories of CKD progression and do not allow predicting the final version of its course. In addition, cohort studies have shown that the risks of developing kidney disease and cardiovascular disease may vary depending on the CKD phenotype. A better understanding of the clinical course of CKD in diabetes mellitus is critical to improve risk stratification and enable early initiation of drugs that slow the progression of CKD, such as SGLT-2 inhibitors, RAAS inhibitors and mineralocorticoid receptor antagonists.
About the Authors
T. Yu. Demidova
Pirogov Russian National Research Medical University
Russian Federation
Russian Federation
Tatiana Y. Demidova – MD, professor, head of the Department of endocrinology, Institute of clinical medicine
Moscow
A. S. Teplova
Pirogov Russian National Research Medical University
Russian Federation
Russian Federation
Anna S. Teplova – MD, assistant at the Department of endocrinology, Institute of clinical medicine
Moscow
A. S. Ochirova
Pirogov Russian National Research Medical University
Russian Federation
Russian Federation
Ayana S. Ochirova – resident of the Department of endocrinology, Institute of clinical medicine
Moscow
References
1. Алгоритмы специализированной медицинской помощи больным сахарным диабетом. Под ред. И.И. Дедова, М.В Шестаковой, А.Ю. Майорова. 11-й выпуск. М.; 2023. doi: https://doi.org/10.14341/DM13042.
2. Sui Z, Wang J, Cabrera C et al. Aetiology of chronic kidney disease and risk factors for disease progression in Chinese subjects: A single-centre retrospective study in Beijing. Nephrology (Carlton). 2020; 25(9): 714–22. doi: 10.1111/пер.13714.
3. de Boer IH, Khunti K, Sadusky T et al. Diabetes management in chronic kidney disease: A consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO). Diabetes Care. 2022; 45(12): 3075–90. doi: 10.2337/dci22-0027.
4. Анциферов М.Б., Котенко О.Н., Кобалава Ж.Д. с соавт. Оценка распространенности хронической болезни почек у пациентов с сахарным диабетом 2 типа, госпитализированных в многопрофильные стационары: результаты проспективного наблюдательного многоцентрового исследования (КРЕДО). Сахарный диабет. 2024; 27(3): 204–213. doi: 10.14341/DM13146
5. Шамхалова М.Ш., Викулова О.К., Железнякова А.В. с соавт. Эпидемиология хронической болезни почек у пациентов с диабетом в Российской Федерации по данным Федерального регистра сахарного диабета (2010–2022 гг.). Сахарный диабет. 2023; 26(5): 404–417. doi: 10.14341/DM13090
6. Демидова Т.Ю., Измайлова М.Я. Предсказательные модели высокого риска развития сердечной недостаточности, атеросклеротических заболеваний и ХБП у пациентов с сахарным диабетом 2 типа. FOCUS Эндокринология. 2024; 1(5): 6–13. doi: 10.62751/2713-0177-2024-5-1-01.
7. Демидова Т.Ю., Измайлова М.Я., Анциферов М.Б. Возможности ранней диагностики хронической сердечной недостаточности и хронической болезни почек у пациентов сахарным диабетом 2-го типа на госпитальном этапе. Терапия. 2023; 9(9): 16–28. doi: 10.18565/therapy.2023.9.16-28.
8. Трубицына Н.П., Зайцева Н.В., Северина А.С., Шамхалова М.Ш. Хроническая болезнь почек у пациентов с сахарным диабетом 2 типа: новые мишени лекарственного воздействия. Сахарный диабет. 2022; 25(5): 492–498. doi: 10.14341/DM12944.
9. Oshima M, Shimizu M, Yamanouchi M et al. Trajectories of kidney function in diabetes: A clinicopathological update. Nat Rev Nephrol. 2021; 17(11): 740–50. doi: 10.1038/s41581-021-00462-y.
10. Araki S, Haneda M, Sugimoto T et al. Factors associated with frequent remission of microalbuminuria in patients with type 2 diabetes. Diabetes. 2005; 54(10): 2983–87. doi: 10.2337/diabetes.54.10.2983.
11. Yokoyama H, Araki S, Honjo J et al. Association between remission of macroalbuminuria and preservation of renal function in patients with type 2 diabetes with overt proteinuria. Diabetes Care. 2013; 36(10): 3227–33. doi: 10.2337/dc13-0281.
12. Krolewski A, Skupien J, Rossing P et al. Fast renal decline to end-stage renal disease: an unrecognized feature of nephropathy in diabetes. Kidney Int. 2017; 91(6):1300-1311. doi: 10.1016/j.kint.2016.10.046
13. Oshima M, Jun M, Ohkuma T et al.; ADVANCE Collaborative Group. The relationship between eGFR slope and subsequent risk of vascular outcomes and all-cause mortality in type 2 diabetes: the ADVANCE-ON study. Diabetologia. 2019; 62(11): 1988–97. doi: 10.1007/s00125-019-4948-4.
14. Yamanouchi M, Furuichi K, Hoshino J et al.; Research Group of Diabetic Nephropathy, the Ministry of Health, Labour and Welfare, and the Japan Agency for Medical Research and Development. Nonproteinuric versus proteinuric phenotypes in diabetic kidney disease: A propensity score-matched analysis of a nationwide, biopsy-based cohort study. Diabetes Care. 2019; 42(5): 891–902. doi: 10.2337/dc18-1320.
15. Леонова М.В. Ингибиторы натрий-глюкозного котранспортера 2: механизмы кардиоренальной защиты. Consilium Medicum. 2024; 26(4): 225–231. doi: 10.26442/20751753.2024.4.202763ю
16. Heerspink HJL, Stefansson BV, Correa-Rotter R et al.; DAPA-CKD Trial Committees and Investigators. Dapagliflozin in patients with chronic kidney disease. N Engl J Med. 2020; 383(15): 1436–46. doi: 10.1056/NEJMoa2024816.
17. Jongs N, Greene T, Chertow GM et al.; DAPA-CKD Trial Committees and Investigators. Effect of dapagliflozin on urinary albumin excretion in patients with chronic kidney disease with and without type 2 diabetes: A prespecified analysis from the DAPA-CKD trial. Lancet Diabetes Endocrinol. 2021; 9(11): 755–66. doi: 10.1016/S2213-8587(21)00243-6.
18. Neal B, Perkovic V, Matthews DR. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017; 377(21): 2099. doi: 10.1056/NEJMc1712572.
19. Nashar K, Khalil P. Clinical evaluation of dapagliflozin in the management of CKD: Focus on patient selection and clinical perspectives. Int J Nephrol Renovasc Dis. 2022; 15: 289–308. doi: 10.2147/IJNRD.S234282.
20. Wiviott SD, Raz I, Bonaca MP et al.; DECLARE–TIMI 58 Investigators. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2019; 380(4): 347–57. doi: 10.1056/NEJMoa1812389.
21. Patoulias D, Manafis A, Mitas Cet al. Sodium-glucose cotransporter 2 inhibitors and the risk of diabetic ketoacidosis; from pathophysiology to clinical practice. Cardiovasc Hematol Disord Drug Targets. 2018; 18(2): 139–46. doi: 10.2174/1871529X18666180206123149.
22. Lioudaki E, Joslin JR, Trachanatzi E, Androulakis E. The role of sodium-glucose co-transporter (SGLT)-2 inhibitors in heart failure management and implications for the kidneys. Rev Cardiovasc Med. 2022; 23(3): 82. doi: 10.31083/j.rcm2303082.
Review
For citations:
Demidova T.Yu., Teplova A.S., Ochirova A.S. Current understanding of the phenotypes of chronic kidney disease in patients with diabetes mellitus. FOCUS. Endocrinology. 2025;6(1):58-63. (In Russ.) https://doi.org/10.62751/2713-0177-2025-6-1-08
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