Comprehensive Care for People With Diabetic Kidney Disease

p r a c t ic e diabetic kidney disease (DKD) is the leading cause of endstage renal disease (ESRD) and a significant risk factor for progressive macroand microvascular disease. Increasing albuminuria and declining estimated glomerular filtration rate (eGFR) are both independent and additive risk factors for subsequent vascular complications. Given the increased risk that DKD poses for other microand macrovascular complications of diabetes, comprehensive management is crucial. We will review the costs of DKD; the safety and efficacy of blood pressure–independent effects of renin angiotensin aldosterone system (RAAS) inhibition in slowing its progression; and the heightened risk for vascular disease associated with DKD. We will then review the evidence and recommendations for screening and treatment of extrarenal vascular complications and the utility of the patient-centered medical home for comprehensive care of patients with DKD.