BP control in DKD

 Q: In patients with severe albuminuria in Diabetic Kidney Disease (DKD), angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARBs) is preferred to be combined with? (select one) 

A) calcium channel blocker 

B) beta-blocker 

Answer: A

The objective of this question is to highlight the importance of intensive blood pressure (BP) control in DKD and severe albuminuria. Intensive blood sugar and BP control go hand in hand to prevent or prolong time to End-Stage Renal Disease (ESRD) and cardiovascular (CV) events. 

Either an ACE-I or ARBs (NOT BOTH) is the first line of treatment. It should be ideally combined with a dihydropyridine calcium channel blocker. In extremely high albuminuria, a nephrologist may decide to add a diuretic and/or use a nondihydropyridine calcium channel blocker.

Beta-blocker can be added in patients who already have CV pathology or if a clinician will appropriate per a patient situation.

#nephrology

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References:

1. Patney V, Whaley-Connell A, Bakris G. Hypertension Management in Diabetic Kidney Disease. Diabetes Spectr. 2015;28(3):175-180. doi:10.2337/diaspect.28.3.175

2. Sugahara M, Pak WLW, Tanaka T, Tang SCW, Nangaku M. Update on diagnosis, pathophysiology, and management of diabetic kidney disease. Nephrology (Carlton). 2021 Jun;26(6):491-500. doi: 10.1111/nep.13860. Epub 2021 Feb 17. PMID: 33550672.