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how stable is a future with CKD and T2D?

More than 1/3 of patients with type 2 diabetes (T2D) also have chronic kidney disease (CKD).1 CKD multiplies the risk of cardiovascular (CV) events, such as heart attack, stroke, and CV death, and puts patients on a path toward dialysis or kidney transplant.2-4 This risk grows with every stage of CKD.2-4

stage 1 (eGFR 90*)

Kidney damage (≥3 months persistent proteinuria) but normal function2

CKD is progressive,
irreversible,and often goes undetected2,5

stage 2 (eGFR 60-89*)

Kidney damage (≥3 months persistent proteinuria)
and mildly reduced kidney function2

Of US patients in stages 1 or 2,96% are unaware
they have CKD4

stage 3 (eGFR 30-59*)

~50% of kidney function is lost6

Despite use of ACEi's or ARBs,CKD will progressin >1 out of 4 patients in stage 37†

stage 4 (eGFR 15-29*)

Severe kidney damage and loss of function2

Of US patients in stage 4,48% are unaware
they have CKD4

stage 5: kidney failure
(eGFR <15*)

85%-90% of kidney function is lost2;
requires a transplant or dialysis for survival6

For patients who reach end-stage kidney disease,the 5-year survival rate is <40%8

*eGFR measured in mL/min/1.73 m2.

As demonstrated in a study of 3885 patients with type 2 diabetes and stage 3 chronic kidney disease, where more than half of patients were on a background of angiotensin-converting enzyme inhibitors (ACEi's) and angiotensin receptor blockers (ARBs).7

more patients with T2D may be living with CKD than you think

Prevalence of CV and renal complications in patients with T2D5

6.6%
Stroke
9.1%
Coronary
heart disease
9.8% Heart attack
27.8% Chronic
kidney disease

National Health and Nutrition Examination Survey data from 1999 to 2004.

No drugs have been approved by the FDA for the treatment of CKD in T2D in ~20 years—since ARBs.9,10
Do you consider the kidneys when treating T2D?

References: 1. Bailey RA, Wang Y, Zhu V, Rupnow MF. Chronic kidney disease in US adults with type 2 diabetes: an updated national estimate of prevalence based on Kidney Disease: Improving Global Outcomes (KDIGO) staging. BMC Res Notes. doi:10.1186/1756-0500-7-415. 2. Kidney disease statistics for the United States. National Institute of Diabetes and Digestive and Kidney Diseases website. https://www.niddk.nih.gov/health-information/health-statistics/kidney-disease. Accessed June 4, 2019. 3. Afkarian M, Sachs MC, Kestenbaum B, et al. Kidney disease and increased mortality risk in type 2 diabetes. J Am Soc Nephrol. 2013;24(2):302-308. 4. National chronic kidney disease fact sheet, 2017. Centers for Disease Control and Prevention website.  https://www.cdc.gov/diabetes/pubs/pdf/kidney_factsheet.pdf. Accessed June 4, 2019. 5. Deshpande AD, Harris-Hayes M, Schootman M. Epidemiology of diabetes and diabetes-related complications. Phys Ther. 2008;88(11):1254-1264. 6. Key points: living with stage 4 kidney disease. National Kidney Foundation website. https://www.kidney.org/patients/peers/stage4. Accessed June 4, 2019. 7. Vupputuri S, Kimes TM, Calloway MO, et al. The economic burden of progressive chronic kidney disease among patients with type 2 diabetes. J Diabetes Complications. 2014;28(1):10-16. 8. Pálsson R, Patel UD. Cardiovascular complications of diabetic kidney disease. Adv Chronic Kidney Dis. 2014;21(3):273-280. 9. Brenner BM, Cooper ME, de Zeeuw D, et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med. 2001;345(12):861-869. 10. Lewis EJ, Hunsicker LG, Clarke WR, et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med. 2001;345(12):851-860.