Chronic kidney disease in patients with type 2 diabetes mellitus

In the whole world there is an increasing number of patients with diabetes mellitus. As a consequence chronic diabetic kidney disease, which develops in 15-40% of diabetics, becomes more prevalent. Currently diabetic kidney disease is the most frequent cause for the necessity of renal replacement therapy. Both diabetes and chronic kidney disease increase the risk of cardiovascular complications and death. Diabetic kidney disease is characterized by albuminuria (and proteinuria at later stages) and/or decreased glomerular filtration rate. Yearly screening (urinary albumin excretion and eGFR) is recommended to identify kidney disease in patients with diabetes. Prevention and treatment of diabetic kidney disease is based mainly on optimal serum glucose and blood pressure control. In type 2 diabetics with impaired kidney function oral drugs lowering serum glucose have limited use. Most of them are excreted in urine and the risk for hypoglycemia increases. In the recently introduced incretin drug linagliptin is an interesting alternative. This dipeptydilopeptidase-4 inhibitor is excreted in bile and its metabolism and effects are not changed in patients with impaired kidney function.