Table 7

Recommendations for multiple risk factor management in DKD (20,39,183,184)

Risk factorGeneral recommendations for diabetesModifications for DKD
HyperlipidemiaGoal LDL <100 mg/dL or 30–40% reduction from baselineNo specific goal for LDL cholesterol, consider measuring lipids to assess adherence to medication regimen
Treatment consists of dietary modificationsTreatment consists of dietary modifications
Statins are recommended in patients with overt CVD and those over the age of 40 years with another risk factor for CVDStatin or statin-ezetimibe combination is recommended in patients with nondialysis-dependent CKD
For high-CVD-risk patients, <70 mg/dL is an optionReduced doses of statins are recommended for eGFR <60 mL/min/1.73 m2
Initiation of statin therapy has not been shown to be beneficial in patients undergoing chronic dialysis treatment
Statins may reduce CVD risk in kidney transplant recipients
HypertensionGoal BP is <140/80 mmHgGoal BP is <140/90 mmHg
Treatment consists of lifestyle modifications and oral medications that generally should include RAAS blockersGoal BP is <130/80 mmHg if urine ACR >30 mg/g creatinine
Goals for treatment are based primarily on studies of patients with nondiabetic CKD
Treatment consists of lifestyle modifications and oral medications that usually include RAAS blockers
Use of more than one RAAS blocker should generally be avoided
HyperglycemiaGoal is A1C <7%A1C <8% when GFR <60 mL/min/1.73 m2 due to increased risks of hypoglycemia
A goal of <6.5% may be appropriate in early-onset diabetes in younger patientsImprecision of A1C with CKD strengthens reliance of SMBG in making treatment decisions
Treatment consists of lifestyle modification, oral medications, and injectable medications, including insulinDoses of insulin and other injectable and oral medications used to lower blood glucose often need to be reduced for eGFR <60 mL/min/1.73 m2