Mark E Williams
Harvard Medical School, USA
The management of hyperglycemia in patients with chronic kidney disease (CKD) is complex and the goals and methods regarding glycemic control in CKD are not clearly defined. Although aggressive glycemic control seems to be advantageous in early stages of diabetic kidney disease, outcome data supporting tight glycemic control in patients with advanced CKD or end-stage kidney disease (ESKD) are lacking. Challenges in the management of patients with advanced CKD or ESKD include a growing array of available oral and injectable therapies, therapeutic inertia, monitoring difficulties and the complexity of combining various treatment regimens. This presentation will review the known alterations in glucose homeostasis that occur in kidney impairment, updated views on the value of glycemic control and issues with its determination, and recent data on approaches to monitoring glycemic control. Hypoglycemia, more frequent in diabetic CKD patients, will be analyzed. Treatment options for patients with diabetes and CKD or ESKD will be addressed including both the insulin and non-insulin agents that are currently available along with their indications and contraindications. The presentation will provide information to help clinicians and researchers in decision-making in order to reach individualized glycemic goals using appropriate therapy for patients with CKD or ESKD.
