The Kidney Disease: Improving Global Outcomes (KDIGO) Work Group recently released an updated guideline on treatment of patients with diabetes and chronic kidney disease (CKD). A summary published by Annals of Internal Medicine on Jan. 10 focused on the key recommendations pertinent to comprehensive care, glycemic monitoring and targets, lifestyle interventions, antihyperglycemic therapies, and educational and integrated care approaches.
The update recommends:
- a layered approach to care, starting with a foundation of lifestyle interventions and first-line pharmacotherapy demonstrated to improve clinical outcomes;
- medications that improve intrarenal hemodynamics, such as renin-angiotensin system inhibitors, sodium-glucose cotransporter-2 (SGLT2) inhibitors, nonsteroidal mineralocorticoid receptor antagonists (MRAs), diuretics, and other antihypertensive medications;
- preserving kidney function and maintaining well-being rather than replacing kidney function; and
- team-based, integrated care focused on risk evaluation and patient empowerment to provide comprehensive care for patients with diabetes and CKD.
The full clinical guideline update, which includes 13 recommendations and 52 practice points, is available on the KDIGO website.
An accompanying editorial called the updated recommendations exciting for their potential to change the natural history of CKD and diabetes but noted that their effect could be limited by barriers at multiple levels, including inequities, uncertainty about expected benefits, and costs. “Overall, the KDIGO 2022 guidelines provide important support for widespread expansion and adoption of SGLT2 inhibitors, nonsteroidal MRAs, and [glucagon-like peptide-1 receptor agonists]—the impact of which will be determined by how effective the health care system and its patients and clinicians are at overcoming individual and structural barriers,” the editorialists wrote.