Chronic kidney disease (CKD) is among the most prevalent and dire
complications of diabetes mellitus in adults across the world. Diabetes substantially contributes to the burden of
kidney disease, such that one third to one half of CKD in the United States and many other countries is attributable to
diabetic kidney disease (DKD). As DKD progresses to
end-stage renal disease (
ESRD), patients are at heightened risk for atypical glycemic complications, including the development of burnt-out diabetes, manifested by
hypoglycemic bouts and poor outcomes. Furthermore, even in the absence of diabetes,
hypoglycemia is a frequent occurrence in CKD patients that may contribute to their high burden of
cardiovascular disease and death. Extrapolation of data from clinical trials in high-cardiovascular-risk populations and observational studies in patients with non-dialysis-dependent (NDD) CKD and
ESRD suggest that moderate glycemic targets defined by
glycated hemoglobin levels of 6% to 8% and
glucose levels of 100 to 150 mg/dL are associated with better survival in DKD patients. However, given the imprecision of
glycated hemoglobin levels in
kidney disease, further research is needed to determine the optimal glycemic metric and target in diabetic NDD-CKD and
ESRD patients. Given their exceedingly high cardiovascular morbidity and mortality, there is a compelling need for further investigation of how to optimally manage dysglycemia in the NDD-CKD and
ESRD populations.