Diabetic kidney disease
Screening with ACR and eGFR, when the kidney disease probably isn't diabetic, and the four drug pillars (RAS blockade, SGLT2 inhibitor, finerenone, GLP-1 receptor agonist) with their trials.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Diabetes causes about 40% of new kidney failure in Australia, and over 70% in First Nations Australians (KHA 2024). About 1 in 3 people with diabetes develop CKD.
- Diagnose on persistent albuminuria and/or reduced eGFR in a person with diabetes, usually with retinopathy, after excluding other causes.
- Treatment rests on four pillars: maximum tolerated ACE inhibitor or ARB, an SGLT2 inhibitor, and in type 2 diabetes finerenone and a GLP-1 receptor agonist. Add BP control, a statin and individualised glucose targets.
Loading the rest of the note…
Finished reading?
Sources
- Chronic Kidney Disease (CKD) Management in Primary Care, 5th editionAU/NZKidney Health Australia, 2024
- Australian Type 2 Diabetes Glycaemic Management AlgorithmAU/NZAustralian Diabetes Society, September 2026
- KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney International 2022;102(5S):S1-S127Kidney Disease Improving Global Outcomes, 2022 (2026 update: public review completed, being revised, not yet final)
- Perkovic V et al. Effects of semaglutide on chronic kidney disease in patients with type 2 diabetes (FLOW). N Engl J Med 2024;391:109-21New England Journal of Medicine, 2024
- Bakris GL et al. Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes (FIDELIO-DKD). N Engl J Med 2020;383:2219-29New England Journal of Medicine, 2020
- Perkovic V et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy (CREDENCE). N Engl J Med 2019;380:2295-306New England Journal of Medicine, 2019
- Diabex (metformin hydrochloride) Australian product informationAU/NZViatris (via medsinfo), August 2026
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback