Monitor blood pressure, serum creatinine, and serum potassium levels within 2 to 4 weeks after initiating or increasing the dose of an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB). ACEi or ARB therapy should generally be continued unless serum creatinine increases by more than 30% within 4 weeks of initiation or dose escalation.
According to FDA recommendations, metformin should not be used in men with a serum creatinine level ≥ 1.5 mg/dL or in women with a level ≥ 1.4 mg/dL, or in individuals over 80 years of age with decreased creatinine clearance. However, treatment with metformin is recommended in patients with type 2 diabetes (T2D), chronic kidney disease (CKD), and an estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m².
ADA/KDIGO Consensus Statements:
All patients with type 1 or type 2 diabetes and CKD should be managed using a comprehensive, individualized care plan developed collaboratively between healthcare professionals and the patient. This plan should focus on optimizing nutrition, physical activity, smoking cessation, and weight management. Evidence-based pharmacologic therapies should be implemented to preserve organ function, alongside additional treatments aimed at achieving intermediate targets for glycemic control, blood pressure, and lipid management.
