title: Diabetes management in the kidney patient.
abstract: Hyperglycemia management in chronic kidney disease (CKD) patients presents difficult challenges, partly due to the complexity involved in treating these patients, and partly due to lack of data supporting benefits of tight glycemic control. While hyperglycemia is central to the pathogenesis and management of diabetes, hypoglycemia and glucose variability also contribute to outcomes. Multiple agents with different mechanisms of action are now available; some can lower glucose levels without the risk of hypoglycemia. This article reviews metabolic changes present in kidney impairment/failure, current views about glycemic goals, and treatment options for the diabetic patient with CKD.
authors.affiliation: Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Garg
authors.forename: Mark E
authors.initials: ME
authors.lastname: Williams
mesh_terms: D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D016903:Drug Monitoring; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy* / Q000378:metabolism; D007003:Hypoglycemia / Q000378:metabolism / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D007333:Insulin Resistance / Q000502:physiology; D007668:Kidney / Q000187:drug effects / Q000378:metabolism; D007677:Kidney Function Tests; D008657:Metabolic Clearance Rate / Q000502:physiology; D017063:Outcome Assessment, Health Care; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis / Q000378:metabolism; D020379:Risk Adjustment
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents