Diabetes Management in Chronic Kidney Disease: Synopsis of the 2020 KDIGO Clinical Practice Guideline

Sankar D Navaneethan¹, Sophia Zoungas², M Luiza Caramori³, Juliana C N Chan⁴, Hiddo J L Heerspink⁵, Clint Hurst⁶, Adrian Liew⁷, Erin D Michos⁸, Wasiu A Olowu⁹, Tami Sadusky¹⁰, Nikhil Tandon¹¹, Katherine R Tuttle¹², Christoph Wanner¹³, Katy G Wilkens¹⁴, Lyubov Lytvyn¹⁵, Jonathan C Craig¹⁶, David J Tunnicliffe¹⁷, Martin Howell¹⁷, Marcello Tonelli¹⁸, Michael Cheung¹⁹, Amy Earley¹⁹, Peter Rossing²⁰, Ian H de Boer²¹, Kamlesh Khunti²²

Affiliations

¹ Section of Nephrology and Institute of Clinical and Translational Research, Baylor College of Medicine, and Michael E. DeBakey VA Medical Center, Houston, Texas (S.D.N.).
² Monash University, School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia (S.Z.).
³ University of Minnesota, Minneapolis, Minnesota (M.L.C.).
⁴ Hong Kong Institute of Diabetes and Obesity and Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China (J.C.C.).
⁵ University of Groningen and University Medical Center, Groningen, the Netherlands (H.J.H.).
⁶ Houston, Texas (C.H.).
⁷ Mount Elizabeth Novena Hospital, Singapore (A.L.).
⁸ Johns Hopkins University School of Medicine, Baltimore, Maryland (E.D.M.).
⁹ Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun, Nigeria (W.A.O.).
¹⁰ Seattle, Washington (T.S.).
¹¹ All India Institute of Medical Sciences, New Delhi, India (N.T.).
¹² University of Washington, Spokane, Washington (K.R.T.).
¹³ University Hospital of Würzburg, Würzburg, Germany (C.W.).
¹⁴ Northwest Kidney Centers, Seattle, Washington (K.G.W.).
¹⁵ MAGIC Evidence Ecosystem Foundation, McMaster University, Hamilton, Ontario, Canada (L.L.).
¹⁶ College of Medicine and Public Health, Flinders University, and Cochrane Kidney and Transplant, Adelaide, Australia (J.C.C.).
¹⁷ School of Public Health, The University of Sydney, and Cochrane Kidney and Transplant, Sydney, Australia (D.J.T., M.H.).
¹⁸ University of Calgary, Calgary, Alberta, Canada (M.T.).
¹⁹ KDIGO, Brussels, Belgium (M.C., A.E.).
²⁰ Steno Diabetes Center and University of Copenhagen, Copenhagen, Denmark (P.R.).
²¹ University of Washington, Kidney Research Institute, Seattle, Washington (I.H.D.).
²² Diabetes Research Centre, University of Leicester, and Leicester General Hospital, Leicester, United Kingdom (K.K.).

PMID: 33166222
DOI: 10.7326/M20-5938

Free article

Practice Guideline

Diabetes Management in Chronic Kidney Disease: Synopsis of the 2020 KDIGO Clinical Practice Guideline

Sankar D Navaneethan et al. Ann Intern Med. 2021 Mar.

Free article

. 2021 Mar;174(3):385-394.

doi: 10.7326/M20-5938. Epub 2020 Nov 10.

Authors

Affiliations

¹ Section of Nephrology and Institute of Clinical and Translational Research, Baylor College of Medicine, and Michael E. DeBakey VA Medical Center, Houston, Texas (S.D.N.).
² Monash University, School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia (S.Z.).
³ University of Minnesota, Minneapolis, Minnesota (M.L.C.).
⁴ Hong Kong Institute of Diabetes and Obesity and Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China (J.C.C.).
⁵ University of Groningen and University Medical Center, Groningen, the Netherlands (H.J.H.).
⁶ Houston, Texas (C.H.).
⁷ Mount Elizabeth Novena Hospital, Singapore (A.L.).
⁸ Johns Hopkins University School of Medicine, Baltimore, Maryland (E.D.M.).
⁹ Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun, Nigeria (W.A.O.).
¹⁰ Seattle, Washington (T.S.).
¹¹ All India Institute of Medical Sciences, New Delhi, India (N.T.).
¹² University of Washington, Spokane, Washington (K.R.T.).
¹³ University Hospital of Würzburg, Würzburg, Germany (C.W.).
¹⁴ Northwest Kidney Centers, Seattle, Washington (K.G.W.).
¹⁵ MAGIC Evidence Ecosystem Foundation, McMaster University, Hamilton, Ontario, Canada (L.L.).
¹⁶ College of Medicine and Public Health, Flinders University, and Cochrane Kidney and Transplant, Adelaide, Australia (J.C.C.).
¹⁷ School of Public Health, The University of Sydney, and Cochrane Kidney and Transplant, Sydney, Australia (D.J.T., M.H.).
¹⁸ University of Calgary, Calgary, Alberta, Canada (M.T.).
¹⁹ KDIGO, Brussels, Belgium (M.C., A.E.).
²⁰ Steno Diabetes Center and University of Copenhagen, Copenhagen, Denmark (P.R.).
²¹ University of Washington, Kidney Research Institute, Seattle, Washington (I.H.D.).
²² Diabetes Research Centre, University of Leicester, and Leicester General Hospital, Leicester, United Kingdom (K.K.).

PMID: 33166222
DOI: 10.7326/M20-5938

Abstract

Description: The Kidney Disease: Improving Global Outcomes (KDIGO) organization developed a clinical practice guideline in 2020 for the management of patients with diabetes and chronic kidney disease (CKD).

Methods: The KDIGO Work Group (WG) was tasked with developing the guideline for diabetes management in CKD. It defined the scope of the guideline, gathered evidence, determined systematic review topics, and graded evidence that had been summarized by an evidence review team. The English-language literature searches, which were initially done through October 2018, were updated in February 2020. The WG used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to appraise evidence and rate the strength of the recommendations. Expert judgment was used to develop consensus practice points supplementary to the evidence-based graded recommendations. The guideline document underwent open public review. Comments from various stakeholders, subject matter experts, and industry and national organizations were considered before the document was finalized.

Recommendations: The guideline includes 12 recommendations and 48 practice points for clinicians caring for patients with diabetes and CKD. This synopsis focuses on the key recommendations pertinent to the following issues: comprehensive care needs, glycemic monitoring and targets, lifestyle interventions, antihyperglycemic therapies, and educational and integrated care approaches.

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Comment in

KDIGO made 12 recommendations for managing diabetes with CKD.
Karagiannis T, Tsapas A, Bekiari E. Karagiannis T, et al. Ann Intern Med. 2021 Mar;174(3):JC26. doi: 10.7326/ACPJ202103160-026. Epub 2021 Mar 2. Ann Intern Med. 2021. PMID: 33646846

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Diabetes Management in Chronic Kidney Disease: Synopsis of the 2020 KDIGO Clinical Practice Guideline

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Diabetes Management in Chronic Kidney Disease: Synopsis of the 2020 KDIGO Clinical Practice Guideline

Authors

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LinkOut - more resources

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Medical