Current Guidelines for Management of Chronic Kidney Disease and Diabetes

Released just ahead of American Diabetes Month 2020, Kidney Disease: Improving Global Outcomes (KDIGO) published guidelines highlighting improvements for those struggling with diabetes and Chronic Kidney Disease (CKD) – representing the first comprehensive guidelines on this subject.

The guidelines include 12 recommendations for patient care, as well as 48 practice points for clinicians dealing with diabetes and CKD. The five chapters of the publication, “KDIGO Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease,” focus on comprehensive care, glycemic monitoring and targets, lifestyle interventions, antihyperglycemic therapies, and integrated care approaches to management.

KDIGO addresses Type 1 and Type 2 Diabetes, while also focusing on different severities of CKD, including patients on dialysis or transplant recipients. Overall, the guidance is patient centric and emphasizes general well-being and prevention of kidney failure. It builds upon prior guidelines by offering advice specific to diabetes management and recommends the use of promising therapies called SGLT2 inhibitors.

According to the KDIGO guidelines, diabetes affects eight percent of the world’s population, more than 450 million people, but the number is projected to grow in the coming years. Around 40 percent of people living with diabetes are likely to develop CKD, which can potentially lead to kidney failure.

"These new guidelines provide an important roadmap for earlier interventions and diabetes management that can help slow the progression of chronic kidney disease," said Dr. Dugan Maddux, Vice President of Kidney Disease Initiatives at Fresenius Medical Care North America. "It’s clear that education and awareness remain critical to improving outcomes, and new therapies also show great promise in slowing the progression of CKD. These recommendations should absolutely be read and implemented by both primary care physicians and nephrologists.”

The report’s Executive Summary provides specific highlights and summaries of these guidelines for treating patients with diabetes and CKD that include:

• Comprehensive Care: Use a comprehensive strategy to reduce risks of kidney disease progression including the use of an angiotensin-converting enzyme inhibitor (ACEi) or an angiotensin II receptor blocker (ARB) for patients with diabetes, hypertension, and albuminuria. The recommendations also advise patients to stop using all tobacco products.
• Glycemic Monitoring: Use hemoglobin A1c (HbA1c) to monitor glycemic control.
• Lifestyle Interventions: Advise a more plant-based, lower-sodium diet that focuses on vegetables, fruits, whole grains, and nuts, while reducing processed meats and sweetened beverages. Increase physical exercise to at least 150 minutes a week.
• Antihyperglycemic therapies (Type 2 Diabetes): New drugs are now recommended, including sodium–glucose cotransporter-2 inhibitors (SGLT2i), in combination with lifestyle therapy and other drugs for glycemic control. This new class of drugs has shown great promise in large scale clinical trials.
• Disease Management Approaches: Suggest more structured patient educational programs and team-based, integrated care focused on risk evaluation and patient empowerment.