The incidence of chronic kidney disease in diabetes continues to rise. This is especially true in the elderly population. CKD progresses from glomerular hyperfiltration to overt diabetic nephropathy.Microalbuminuria may not always progress to ESRD and conversely declining renal function may occur in the absence of declining GFR. Its pathogenesis is multifactorial including factors such as AGES, pro-renin, cytokines, nephrin expression, impaired podocyte signaling, changes in the renin–angiotensin–aldosterone system,FGF-23 and vitamin D metabolism. CKD is associated with a considerable burden of chronic complications including a marked increase in anemia, cardiovascular and metabolic bone disease. The increased disability of CKD incurs a great personal and societal cost of health care. Modifiable risk factors that can slow the
progression of CKD include blood pressure and glycemic control, for which there is good evidence as well as life style factors for which less evidence exists. Despite this patients with CKD may progress to ESRD. Although treatment of CKD involves control of modifiable factors, there are few treatments aimed directly at the pathophysiological process of the renal demise. With greater understanding of the underlying mechanisms involved in the development of CKD,
research involving the development of medications targeting these factors is likely to make a greater impact in treating this disease.