In

addition, the salt sensitivity of blood pressure increases in the majority of patients with CKD. There is some evidence that a low salt diet reduces blood pressure and urinary albumin (protein) excretion in diabetic patients with CKD. In addition, a low salt diet is critical to optimize the efficacy of medication used to reduce blood pressure and urinary albumin (protein) excretion. Therefore, we recommend a low salt diet for hypertensive diabetic patients with CKD. Volume depletion associated with intensive salt restriction should this website be avoided in hypertensive diabetic patients with CKD, especially in the elderly. There is no conclusive evidence demonstrating that salt restriction reduces mortality and cardiovascular events in diabetic patients with CKD. Further studies are needed to address this issue. Bibliography 1. Suckling RJ, et al. Cochrane Database Syst Rev. 2010:CD006763. (Level 1)   2. Mühlhauser I, et al. Diabetologia.

1996;39:212–9. (Level 2)   3. Dodson PM, et al. BMJ. 1989;298:227–30. (Level 2)   4. Strojek K, et al. Nephrol Dial Transplant. 2005;20:2113–9. (Level 2)   5. Imanishi M, et al. Diabetes Care. 2001;24:111–6. (Level 2)   6. Thomas MC, et al. Diabetes Care. 2011;34:861–6. (Level 4)   7. Ekinci EI, et al. Diabetes Care. 2011;34:703–9. (Level 4)   8. Houlihan CA, et al. Diabetes Care. 2002;25:663–71. (Level OSI-027 nmr 2)   9. Bakris GL, et al. Ann Intern Med. 1996;125:201–4. (Level 2)   Are RAS inhibitors recommended as the first-line drug for hypertensive diabetic patients with CKD? Blood pressure control reduced the risk of cardiovascular events in patients with diabetic nephropathy. Reno-protective effects of RAS inhibitors beyond blood pressure control have been reported. It has been

reported that in diabetic patients with normoalbuminuria or microalbuminuria, RAS inhibitors prevented increase in the levels of albuminuria or proteinuria. In diabetic patients with macroalbuminuria, renal function was reported to be preserved by the administration of RAS inhibitors. In comparison with CCBs, RAS inhibitors showed similar or more reno-protective effects in diabetic patients with CKD. These data indicated that RAS inhibitors should be the first-line Sitaxentan drug for hypertensive diabetic patients with CKD. Bibliography 1. Turnbull F, et al. Lancet. 2003;362:1527–35. (Level 1)   2. Turnbull F, et al. J Hypertens. 2007;25:951–8. (Level 1)   3. Haller H, et al. N Engl J Med. 2011;364:907–17. (Level 2)   4. The BErgamo NEphrologic DIabetes Complications Trial (BENEDICT) Control Clin Trials. 2003;24:442–61. (Level 2)   5. The EUCLID Study Group. Lancet. 1997;349:1787–92. (Level 2)   6. Sano T, et al. Diabetes Care. 1994;17:420–4. (Level 2)   7. Makino H, et al. Diabetes Care. 2007;30:1577–8. (Level 2)   8. Parving HH, et al. N Engl J Med. 2001;345:870–8. (Level 2)   9. Mauer M, et al. N Engl J Med.