CHRONIC KIDNEY DISEASE IN DIABETES MELLITUS: FROM HYPERGLYCEMIA TO PROGRESSIVE LOSS OF RENAL FUNCTION

Abstract

Chronic kidney disease (CKD) associated with diabetes mellitus is the leading cause of end-stage renal disease worldwide and represents one of the microvascular complications with the greatest clinical, economic, and social impact. Approximately 30–40% of individuals with diabetes mellitus develop some degree of renal impairment during the course of the disease. Diabetic nephropathy results from the interplay between persistent hyperglycemia, intrarenal hemodynamic changes, chronic inflammation, oxidative stress, and genetic predisposition, culminating in glomerulosclerosis, tubulointerstitial fibrosis, and progressive loss of renal function. Significant advances in understanding the underlying pathophysiological mechanisms have been made in recent decades, enabling the development of therapies capable of slowing disease progression—notably sodium-glucose cotransporter-2 (SGLT2) inhibitors, GLP-1 receptor agonists, and non-steroidal mineralocorticoid receptor antagonists such as finerenone. Early diagnosis relies on the periodic assessment of estimated glomerular filtration rate (eGFR) and albuminuria, allowing for timely interventions that reduce the risk of end-stage renal disease and cardiovascular events. This article reviews the key epidemiological, pathophysiological, diagnostic, and therapeutic aspects of CKD associated with diabetes mellitus, highlighting recent advances and future perspectives in the management of this important clinical condition.