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BMC Nephrology
Published in: BMC Nephrology 1/2022

01-12-2022 | Microalbuminuria | Guidelines

Management of hypertension and renin-angiotensin-aldosterone system blockade in adults with diabetic kidney disease: Association of British Clinical Diabetologists and the Renal Association UK guideline update 2021

Authors: D. Banerjee, P. Winocour, T. A. Chowdhury, P. De, M. Wahba, R. Montero, D. Fogarty, A. H. Frankel, J. Karalliedde, P. B. Mark, D. C. Patel, A. Pokrajac, A. Sharif, S. Zac-Varghese, S. Bain, I. Dasgupta, On behalf of the Association of British Clinical Diabetologists and The Renal Association

Published in: BMC Nephrology | Issue 1/2022

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Abstract

People with type 1 and type 2 diabetes are at risk of developing progressive chronic kidney disease (CKD) and end-stage kidney failure. Hypertension is a major, reversible risk factor in people with diabetes for development of albuminuria, impaired kidney function, end-stage kidney disease and cardiovascular disease. Blood pressure control has been shown to be beneficial in people with diabetes in slowing progression of kidney disease and reducing cardiovascular events. However, randomised controlled trial evidence differs in type 1 and type 2 diabetes and different stages of CKD in terms of target blood pressure. Activation of the renin-angiotensin-aldosterone system (RAAS) is an important mechanism for the development and progression of CKD and cardiovascular disease. Randomised trials demonstrate that RAAS blockade is effective in preventing/ slowing progression of CKD and reducing cardiovascular events in people with type 1 and type 2 diabetes, albeit differently according to the stage of CKD. Emerging therapy with sodium glucose cotransporter-2 (SGLT-2) inhibitors, non-steroidal selective mineralocorticoid antagonists and endothelin-A receptor antagonists have been shown in randomised trials to lower blood pressure and further reduce the risk of progression of CKD and cardiovascular disease in people with type 2 diabetes. This guideline reviews the current evidence and makes recommendations about blood pressure control and the use of RAAS-blocking agents in different stages of CKD in people with both type 1 and type 2 diabetes.
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Metadata
Title
Management of hypertension and renin-angiotensin-aldosterone system blockade in adults with diabetic kidney disease: Association of British Clinical Diabetologists and the Renal Association UK guideline update 2021
Authors
D. Banerjee
P. Winocour
T. A. Chowdhury
P. De
M. Wahba
R. Montero
D. Fogarty
A. H. Frankel
J. Karalliedde
P. B. Mark
D. C. Patel
A. Pokrajac
A. Sharif
S. Zac-Varghese
S. Bain
I. Dasgupta
On behalf of the Association of British Clinical Diabetologists and The Renal Association
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Nephrology / Issue 1/2022
Electronic ISSN: 1471-2369
DOI
https://doi.org/10.1186/s12882-021-02587-5

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