Diabetic Nephropathy. Lance Sloan, MD Stephen Fadem, MD. Objectives. Educate physicians and nurses on practical management tips for diabetes control. Identify goals for diabetes therapy in patients with CKD with emphasis on prevention and medication side effects.
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Lance Sloan, MD
Stephen Fadem, MD
Each year in Texas 206/million patients start dialysis because of diabetic nephropathy.
Texas has the highest incidence in the nation. Source: USRDS
Dialysis management of diabetic ESRD patients, particularly with heart failure
Blood Pressure Control
Adapted from American Journal of Kidney Diseases, Vol 43, No 5, Suppl Suppl 1 (May), 2004: pp S14-S15
Maschio. N Engl J Med. 1996;334:939.
Proteinuria is a powerful determinant of renal deterioration.
Source: The New England Journal of Medicine -- November 12, 1998 -- Vol. 339, No. 20 Mechanisms of Disease: Pathophysiology of Progressive Nephropathies Giuseppe Remuzzi, Tullio Bertani
Lewis EJ, et al. N Engl J Med. 1993;329:1456-1462.
Am J Kidney Dis. 2005 Dec;46(6):1080-7.
Elderly diabetic patients
Medical insurance claims
65 years and older
30,750 patients studied (58.7% also had high blood pressure and/or protein in the urine)
Of these only 50.7% (CI 50.0-51.4) received an ACE or ARB
Adapted from Hirsch IB, Edelman SV Practical Management of Type 1 Diabetes, PCI Book,, West Islip Ny (2005)