Management of diabetes in patients with chronic kidney disease

Management of patients with diabetes mellitus and chronic kidney disease (CKD) is a challenging task because multiple factors in each condition may impact the other. Glycemic control offers significant benefits in the prevention of diabetic kidney disease (DKD), but other associated morbidities are also important to address. Patients with diabetes with insufficient glycemic and blood pressure control are at a high risk for developing both cardiovascular disease and progression of nephropathy. This article discusses proper screening, identification, and management in the different stages of DKD, with special considerations for dialysis and transplant patients. We also review information on altered metabolism of medications and the appropriate use of diabetic agents, including recommendations for management of glucose control in CKD.