{"id":16242,"date":"2023-08-03T09:06:49","date_gmt":"2023-08-03T08:06:49","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=16242"},"modified":"2026-03-10T15:22:52","modified_gmt":"2026-03-10T15:22:52","slug":"diabetes-ckd","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/diabetes\/diabetes-ckd\/","title":{"rendered":"Diabetes CKD"},"content":{"rendered":"\n<p><strong>Information<\/strong><\/p>\n\n\n\n<p>Diabetes kidney disease or nephropathy is defined as albuminuria and progressive reduction in eGFR in the setting of longstanding diabetes. This tends to be associated with diabetic retinopathy. Management is focused on good BP and glycaemic control to prevent progressive decline in eGFR.<\/p>\n\n\n\n<p>Urinary protein measurements will primarily be measured using Albumin Creatinine Ratio (ACR) with Protein Creatinine Ratio (PCR) only checked if urine albumin is &gt; 850mg\/mmol.<\/p>\n\n\n\n<p><span style=\"text-decoration: underline\">Microalbuminuria (MA)<\/span><\/p>\n\n\n\n<p>Defined as ACR &gt; 3mg\/mmol in males and females<\/p>\n\n\n\n<p>Confirmed on at least 2 of 3 ideally early morning samples<\/p>\n\n\n\n<p><span style=\"text-decoration: underline\">Proteinuria<\/span> <\/p>\n\n\n\n<p>Defined as ACR &gt; 30mg\/mmol in males and females<\/p>\n\n\n\n<p><strong>M.A &amp; C.K &#8211; 10-03-26<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who can refer:<\/h4>\n\n\n\n<p>Primary and Secondary care clinicians<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<p>Consider referral to one of the Joint Renal Diabetes Clinics (at RIE, WGH or SJH) if intensive multi-factorial intervention may help to prevent progression to stage 4 CKD. <\/p>\n\n\n\n<p>We have no set referral criteria but if there is progressive worsening of CKD with rising proteinuria in a patient with modifiable risk factors, we would be happy to consider review.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<p>Any patients already under Renal clinic follow up.<\/p>\n\n\n\n<p>Any patients who are frail and wouldn\u2019t benefit from intensive risk factor management<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p>Via SCI Gateway referral to <strong>RIE<\/strong>\/<strong>WGH<\/strong>\/<strong>SJH<\/strong> <em>(depending on patient\u2019s location)<\/em> &gt; <strong>Diabetes<\/strong><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><span style=\"text-decoration: underline\">Primary care management of MA\/proteinuria and Diabetes<\/span><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Start ACE inhibitor or ARB regardless of BP and titrate to maximum tolerated dose in Type 1 and Type 2 Diabetes<\/li>\n\n\n\n<li>Add SGLT2 inhibitor if persistent MA\/proteinuria\u00a0in Type 2 Diabetes only:\n<ul class=\"wp-block-list\">\n<li>Dapagliflozin 10mg once daily (eGFR &gt; 15)<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>If frail or elderly, consider whether ACE\/ARB\/SGLT2 appropriate given known side effects<\/li>\n\n\n\n<li>Target BP should be individualised based on other co-morbidities<ul><li>Most adults with CKD and MA\/proteinuria should aim for &lt; 130\/80mmHg<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>If frail or age &gt; 80, aim &lt; 150\/80mmHg or as tolerated<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Optimise HbA1c\n<ul class=\"wp-block-list\">\n<li>Individualised target but &lt; 58 mmol\/mol in most adults<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Start statin if not already taking<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>ABCD and UKKA 2024 Summary of CKD Management in Type 2 Diabetes:<\/p>\n\n\n\n<p><a href=\"https:\/\/www.ukkidney.org\/sites\/default\/files\/Overview%20of%20ABCD-UKKA%20Guidelines%20October%202024.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Overview of ABCD-UKKA Guidelines October 2024.pdf<\/a><\/p>\n\n\n\n<p>ABCD Guidelines for managing hyperglycaemia in patients with diabetes and CKD:<\/p>\n\n\n\n<p><a href=\"https:\/\/abcd.care\/sites\/abcd.care\/files\/site_uploads\/Resources\/Position-Papers\/Management-of-hyperglycaemia-in-adults%20-with-DKD.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Management of hyperglycaemia in adults with DKD_final (abcd.care)<\/a><\/p>\n\n\n\n<p>ABCD and Diabetes UK guidance on use of SGLT2s by non specialists in UK:<\/p>\n\n\n\n<p><a href=\"https:\/\/eur01.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS1470211824031348%3Fvia%253Dihub&amp;data=05%7C02%7Cmohammed.alshaikly%40nhs.scot%7Ce59b36eb0d7a4444746b08de7eb30d24%7C10efe0bda0304bca809cb5e6745e499a%7C0%7C0%7C639087504642144916%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&amp;sdata=UbWdAD34MLAwUQbH8%2BG4sCyywacQULNetPo8Db4ZeOg%3D&amp;reserved=0\" target=\"_blank\" rel=\"noreferrer noopener\">Association of British Clinical Diabetologists (ABCD) and Diabetes UK joint position statement and recommendations for non-diabetes specialists on the use of sodium glucose co-transporter 2 inhibitors in people with type 2 diabetes (January 2021) &#8211; ScienceDirect<\/a><\/p>\n\n\n\n<p>ABCD guideline on managing hypertension in patients with diabetes and CKD:<\/p>\n\n\n\n<p><a href=\"https:\/\/abcd.care\/sites\/abcd.care\/files\/site_uploads\/Resources\/Position-Papers\/Management-of-hypertension-and-RAAS-blockade-in-adults-with-DKD.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Management-of-hypertension-and-RAAS-blockade-in-adults-with-DKD.pdf (abcd.care)<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Information Diabetes kidney disease or nephropathy is defined as albuminuria and progressive reduction in eGFR in the setting of longstanding diabetes. This tends to be associated with diabetic retinopathy. Management is focused on good BP and glycaemic control to prevent progressive decline in eGFR. Urinary protein measurements will primarily be measured using Albumin Creatinine Ratio<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":3854,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[977],"class_list":["post-16242","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-diabetes-ckd"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/diabetes\/https-apps-nhslothian-scot-refhelp-diabetes-ckd\/\" rel=\"tag\">Diabetes CKD<\/a>","rttpg_excerpt":"Information Diabetes kidney disease or nephropathy is defined as albuminuria and progressive reduction in eGFR in the setting of longstanding diabetes. This tends to be associated with diabetic retinopathy. Management is focused on good BP and glycaemic control to prevent progressive decline in eGFR. Urinary protein measurements will primarily be measured using Albumin Creatinine Ratio","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/16242","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=16242"}],"version-history":[{"count":7,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/16242\/revisions"}],"predecessor-version":[{"id":27204,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/16242\/revisions\/27204"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3854"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=16242"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=16242"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}