Table 2.

Contemporary management of diabetic kidney disease (DKD)

Therapeutic Options	Comment
BP control	Guidelines’ goal of <130/<80 mmHg is not supported by data from randomized controlled trials. Ideal BP is not known
RAAS blockade	Strongest evidence supports ARB use. Combination ACEI/ARB or direct renin inhibitor use are not supported by data
Glycemic control	Intensive control (HbA1c≤7%) protects against micro- or macroalbuminuria but data are conflicting regarding effects on CKD progression. Also carries risk of serious complications
SGLT-2 inhibition	Promising evidence for renoprotection from secondary end point in EMPA-REG OUTCOME Trial. Awaiting results of additional confirmatory trials
Weight loss	Preliminary data suggest a benefit but require confirmation

RAAS, renin-angiotensin-aldosterone system; ARB, angiotensin receptor blocker; ACEI, angiotensin-converting enzyme inhibitor; HbA1c, hemoglobin A1c; SGLT-2, sodium-glucose cotransporter 2; EMPA-REG OUTCOME, Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2.