title: Pleiotropic effects of type 2 diabetes management strategies on renal risk factors.
abstract: In parallel with the type 2 diabetes pandemic, diabetic kidney disease has become the leading cause of end-stage renal disease worldwide, and is associated with high cardiovascular morbidity and mortality. As established in landmark randomised trials and recommended in clinical guidelines, prevention and treatment of diabetic kidney disease focuses on control of the two main renal risk factors, hyperglycaemia and systemic hypertension. Treatment of systemic hypertension with angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers is advocated because these drugs seem to exert specific renoprotective effects beyond blood pressure lowering. Emerging evidence shows that obesity, glomerular hyperfiltration, albuminuria, and dyslipidaemia might also adversely affect the kidney in diabetes. Control of these risk factors could have additional benefits on renal outcome in patients with type 2 diabetes. However, despite multifactorial treatment approaches, residual risk for the development and progression of diabetic kidney disease in patients with type 2 diabetes remains, and novel strategies or therapies to treat the disease are urgently needed. Several drugs used in the treatment of type 2 diabetes are associated with pleiotropic effects that could favourably or unfavourably change patients' renal risk profile. We review the risk factors and treatment of diabetic kidney disease, and describe the pleiotropic effects of widely used drugs in type 2 diabetes management on renal outcomes, with special emphasis on antihyperglycaemic drugs.
authors.affiliation: Department of Internal Medicine and Diabetes Centre, VU University Medical Centre, Amsterdam, Netherlands. Electronic address: ma.muskiet@vumc.nl.
authors.forename: Marcel H A
authors.initials: MH
authors.lastname: Muskiet
authors.affiliation: Department of Internal Medicine and Diabetes Centre, VU University Medical Centre, Amsterdam, Netherlands.
authors.forename: Lennart
authors.initials: L
authors.lastname: Tonneijck
authors.affiliation: Department of Internal Medicine and Diabetes Centre, VU University Medical Centre, Amsterdam, Netherlands.
authors.forename: Mark M
authors.initials: MM
authors.lastname: Smits
authors.affiliation: Department of Internal Medicine and Diabetes Centre, VU University Medical Centre, Amsterdam, Netherlands.
authors.forename: Mark H H
authors.initials: MH
authors.lastname: Kramer
authors.affiliation: Department of Clinical Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands.
authors.forename: Hiddo J Lambers
authors.initials: HJ
authors.lastname: Heerspink
authors.affiliation: Department of Internal Medicine and Diabetes Centre, VU University Medical Centre, Amsterdam, Netherlands.
authors.forename: Daniël H
authors.initials: DH
authors.lastname: van Raalte
mesh_terms: D001835:Body Weight / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D003928:Diabetic Nephropathies / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D019468:Disease Management; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000188:drug therapy; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D009765:Obesity / Q000150:complications; D012307:Risk Factors; D040242:Risk Reduction Behavior
chemical_list: D007004:Hypoglycemic Agents