Clinical therapeutic strategies for early stage of diabetic kidney disease

Table 1 Effects of intensive glucose control on the onset and progression of diabetic kidney disease

Study	HbA1c		Outcome of albuminuria or renal events
	Intensive treatment	Conventional treatment
ACCORD[45]	6.4% vs 7.6%		21% ↓ in onset of microalbuminuria
			32% ↓ in progression to macroalbuminuria
ADVANCE[46]	6.5% vs 7.3%		9% ↓ in onset of microalbuminuria
			30% ↓ in progression to macroalbuminuria
			21% ↓ in renal events
			New onset macroalbuminuria
			Doubling of serum Cr
			Kidney replacement therapy
			Death due to kidney disease
VADT[47]	6.9% vs 8.4%		32% ↓ in progression from normal to microalbuminuria or macroalbuminuria
			37% ↓ in progression from normal to microalbuminuria to macroalbuminuria
			34% ↓ in any increase in albuminuria

ACCORD: Action to Control Cardiovascular Risk in Diabetes; ADVANCE: Action in Diabetes and Vascular disease: Preterax and Diamicron MR Controlled Evaluation; VADT: Veterans Affairs Diabetes Trial.

Table 2 Target of blood pressure in diabetic kidney disease (different of clinical guidelines)

Clinical guideline	Target population	Target of blood pressure
Standard of Medical Care in Diabetes-2014 (ADA)	Diabetic patients	< 140/80 mmHg (< 130 mmHg, younger patients if it can be achieved without undue treatment burden)
KDIGO 2012 CKD guideline	Diabetes + CKD
UAE < 30 mg/24 h or ACR < 30 mg/gCr	≤ 140/90 mmHg
	UAE ≥ 30 mg/24 h or ACR ≥ 30 mg/gCr	≤ 130/80 mmHg
JNC8	Diabetic patients	< 140/90 mmHg
	CKD patients

CKD: Chronic kidney disease; UAE: Urinary albumin excretion; ACR: Albumin creatinine ratio; ADA: American Diabetes Association; KDIGO: The kidney Disease Improving Global Outcomes; JNC8: The Eighth Joint National Committee.