Induced changes by chronic kidney disease in patients with diabetes

Diabetic nephropathy affects about 25-40% of diabetic patients and is a marker of morbimortality. Complications related to kidney failure in these patients become even more relevant with decreasing glomerular filtration rate. Cardiovascular disease is the most relevant complication, which include coronary disease, arterial hypertension, left ventricular hypertrophy, congestive cardiac insufficiency, arrhythmias and pericarditis. Other related renal complications will influence the prognosis and evolution of diabetic patients such as anemia, hemorrhagic complications, thrombotic phenomena, alterations of immune response and susceptibility to infections. All these complications, which are present in the patient with diabetic nephropathy, force towards a multifactor approach, which includes firstly the prevention of the appearance/progression of the complications through a control of the risk factors for macro and microangiopathy as glycemic and blood pressure control, proteinuria reduction, avoiding nicotine abuse, keeping closed to the ideal weight, salt intake reduction, antiaggregant treatment and statins therapy, as well as preventing additional renal toxicity.