2022 update provides important clarifications to 2020 guidelines
URL goes live when the embargo lifts
The latest clinical practice guideline from the Kidney Disease: Improving Global Outcomes (KDIGO) organization offers advice for treating patients with diabetes and chronic kidney disease (CKD). A synopsis published in Annals of Internal Medicine focuses on the key recommendations pertinent to the following issues: comprehensive care, glycemic monitoring and targets, lifestyle interventions, antihyperglycemic therapies, and educational and integrated care approaches to management.
The KDIGO guideline update is based upon literature searches last conducted in December 2021, limiting the searches to randomized controlled trials only, and updated these searches in February 2022 at the time of the public review. The evidence synthesis and meta-analysis methods undertaken for the KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease were followed for the 2022 guideline update.
Authors from the KDIGO Work Group summarized the guideline update for ease of reference in clinical practice. The update recommends:
- a layered approach to care, starting with a foundation of lifestyle interventions and first-line pharmacotherapy demonstrated to improve clinical outcomes;
- the serial introduction of medications that improve intrarenal hemodynamics (such as RAS inhibitors, SGLT2 inhibitors, MRAs, diuretics, and other antihypertensive medications);
- that health care providers should focus on preserving kidney function and maintaining well-being rather than replacing kidney function; and
- that policymakers and institutional decision makers implement 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 can be accessed at https://kdigo.org/guidelines/diabetes-ckd.