Kidney Week 2025 Early Program - Diabetes Management for the Nephrology Care Team: New Technology and New Drugs-Panel Discussion: Case Studies in Diabetes Management

Video Transcription

Video Summary

The panel discusses evolving management of diabetes with chronic kidney disease (CKD) using case-based examples. In the first case (71-year-old woman with T2D, eGFR 43, UACR 330, obesity, A1C 7.7% on metformin, DPP-4 inhibitor, ACE inhibitor), experts emphasize that A1C may be misleading in CKD and suggest using CGM/GMI. They recommend replacing the DPP-4 inhibitor with a GLP-1 receptor agonist for glycemic control, weight loss, and cardiovascular/kidney benefit, and consider adding an SGLT2 inhibitor while monitoring for blood pressure drops and an initial eGFR “dip.”  <br /><br />The second case (54-year-old man on ACE inhibitor + empagliflozin with persistent albuminuria 400 mg/g, A1C 8, BMI 32) highlights “competing risk” assessment: kidney-failure risk calculators may look modest while cardiovascular (especially heart failure) risk is high. The group discusses adding therapies targeting residual risk—GLP-1 RA for obesity/glycemia and possibly a nonsteroidal MRA for albuminuria—plus screening for modifiable factors like sleep apnea and tailoring lifestyle goals realistically.  <br /><br />A third case shows that starting incretin therapy in insulin-treated CKD requires proactive insulin and antihypertensive/diuretic down-titration and close follow-up to prevent hypoglycemia and hypotension.  <br /><br />A final dialysis case (obese patient seeking transplant) underscores monitoring dry weight, volume status, nutrition, binders, insulin needs, and dialysis frequency during rapid GLP-1–associated weight loss.

Asset Subtitle

Irl B. Hirsch, Joshua J. Neumiller, Janani Rangaswami, Connie Rhee, Daniël H. van Raalte

Meta Tag

Module DKD

Speaker FACULTY FACULTY

Keywords

type 2 diabetes

chronic kidney disease

GLP-1 receptor agonist

SGLT2 inhibitor

albuminuria (UACR)

continuous glucose monitoring (CGM)

nonsteroidal mineralocorticoid receptor antagonist (MRA)

dialysis and transplant candidacy