Diabetes Management in Chronic Kidney Disease: Synopsis of the KDIGO 2022 Clinical Practice Guideline Update

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, Jonathan C Craig¹⁵, David J Tunnicliffe¹⁶, Marcello Tonelli¹⁷, Michael Cheung¹⁸, Amy Earley¹⁸, Peter Rossing¹⁹, Ian H de Boer²⁰, Kamlesh Khunti²¹

Affiliations

¹ Section of Nephrology, Department of Medicine, Selzman Institute for Kidney Health, Baylor College of Medicine, Institute of Clinical and Translational Research, Baylor College of Medicine, and Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas (S.D.N.).
² School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (S.Z.).
³ Department of Endocrinology and Metabolism, Cleveland Clinic Foundation, Cleveland, Ohio, and Division of Diabetes, Endocrinology and Metabolism, University of Minnesota, Minneapolis, Minnesota (M.L.C.).
⁴ Department of Medicine and Therapeutics, 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.N.C.).
⁵ Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (H.J.L.H.).
⁶ Houston, Texas (C.H.).
⁷ The Kidney & Transplant Practice, Mount Elizabeth Novena Hospital, Singapore (A.L.).
⁸ Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland (E.D.M.).
⁹ Pediatric Nephrology and Hypertension Unit, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, State of Osum, Nigeria (W.A.O.).
¹⁰ Seattle, Washington (T.S.).
¹¹ Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India (N.T.).
¹² Division of Nephrology, University of Washington, Spokane, Washington (K.R.T.).
¹³ Division of Nephrology, University Hospital of Würzburg, Würzburg, Germany (C.W.).
¹⁴ Nutrition and Fitness Services, Northwest Kidney Centers, Seattle, Washington (K.G.W.).
¹⁵ College of Medicine and Public Health, Flinders University, Adelaide, South Australia, and Cochrane Kidney and Transplant, Sydney, New South Wales, Australia (J.C.C.).
¹⁶ Cochrane Kidney and Transplant and Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia (D.J.T.).
¹⁷ Department of Medicine, University of Calgary, Calgary, Alberta, Canada (M.T.).
¹⁸ KDIGO, Brussels, Belgium (M.C., A.E.).
¹⁹ Steno Diabetes Center Copenhagen and University of Copenhagen, Copenhagen, Denmark (P.R.).
²⁰ Kidney Research Institute, University of Washington, Seattle, Washington (I.H.B.).
²¹ Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, United Kingdom (K.K.).

PMID: 36623286
DOI: 10.7326/M22-2904

Free article

Diabetes Management in Chronic Kidney Disease: Synopsis of the KDIGO 2022 Clinical Practice Guideline Update

Sankar D Navaneethan et al. Ann Intern Med. 2023 Mar.

Free article

. 2023 Mar;176(3):381-387.

doi: 10.7326/M22-2904. Epub 2023 Jan 10.

Authors

Affiliations

¹ Section of Nephrology, Department of Medicine, Selzman Institute for Kidney Health, Baylor College of Medicine, Institute of Clinical and Translational Research, Baylor College of Medicine, and Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas (S.D.N.).
² School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (S.Z.).
³ Department of Endocrinology and Metabolism, Cleveland Clinic Foundation, Cleveland, Ohio, and Division of Diabetes, Endocrinology and Metabolism, University of Minnesota, Minneapolis, Minnesota (M.L.C.).
⁴ Department of Medicine and Therapeutics, 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.N.C.).
⁵ Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands (H.J.L.H.).
⁶ Houston, Texas (C.H.).
⁷ The Kidney & Transplant Practice, Mount Elizabeth Novena Hospital, Singapore (A.L.).
⁸ Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland (E.D.M.).
⁹ Pediatric Nephrology and Hypertension Unit, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, State of Osum, Nigeria (W.A.O.).
¹⁰ Seattle, Washington (T.S.).
¹¹ Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India (N.T.).
¹² Division of Nephrology, University of Washington, Spokane, Washington (K.R.T.).
¹³ Division of Nephrology, University Hospital of Würzburg, Würzburg, Germany (C.W.).
¹⁴ Nutrition and Fitness Services, Northwest Kidney Centers, Seattle, Washington (K.G.W.).
¹⁵ College of Medicine and Public Health, Flinders University, Adelaide, South Australia, and Cochrane Kidney and Transplant, Sydney, New South Wales, Australia (J.C.C.).
¹⁶ Cochrane Kidney and Transplant and Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia (D.J.T.).
¹⁷ Department of Medicine, University of Calgary, Calgary, Alberta, Canada (M.T.).
¹⁸ KDIGO, Brussels, Belgium (M.C., A.E.).
¹⁹ Steno Diabetes Center Copenhagen and University of Copenhagen, Copenhagen, Denmark (P.R.).
²⁰ Kidney Research Institute, University of Washington, Seattle, Washington (I.H.B.).
²¹ Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, United Kingdom (K.K.).

PMID: 36623286
DOI: 10.7326/M22-2904

Abstract

Description: The KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease is an update of the 2020 guideline from Kidney Disease: Improving Global Outcomes (KDIGO).

Methods: The KDIGO Work Group updated the guideline, which included reviewing and grading new evidence that was identified and summarized. As in the previous guideline, the Work Group used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to appraise evidence and rate the strength of recommendations and expert judgment to develop consensus practice points. New evidence led to updating of recommendations in the chapters Comprehensive Care in Patients With Diabetes and CKD (Chapter 1) and Glucose-Lowering Therapies in Patients With T2D and CKD (Chapter 4). New evidence did not change recommendations in the chapters Glycemic Monitoring and Targets in Patients With Diabetes and CKD (Chapter 2), Lifestyle Interventions in Patients With Diabetes and CKD (Chapter 3), and Approaches to Management of Patients With Diabetes and CKD (Chapter 5).

Recommendations: The updated guideline includes 13 recommendations and 52 practice points for clinicians caring for patients with diabetes and chronic kidney disease (CKD). A focus on preserving kidney function and maintaining well-being is recommended using a layered approach to care, starting with a foundation of lifestyle interventions, self-management, and first-line pharmacotherapy (such as sodium-glucose cotransporter-2 inhibitors) demonstrated to improve clinical outcomes. To this are added additional drugs with heart and kidney protection, such as glucagon-like peptide-1 receptor agonists and nonsteroidal mineralocorticoid receptor antagonists, and interventions to control risk factors for CKD progression and cardiovascular events, such as blood pressure, glycemia, and lipids.

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Comment in

2022 Clinical Practice Guideline Update for Diabetes Management of Chronic Kidney Disease: An Important First Step, More Work to Do.
Saunders M, Laiteerapong N. Saunders M, et al. Ann Intern Med. 2023 Mar;176(3):417-418. doi: 10.7326/M22-3635. Epub 2023 Jan 10. Ann Intern Med. 2023. PMID: 36623285 No abstract available.
KDIGO provided recommendations on SGLT2 inhibitors and nonsteroidal MRAs in patients with diabetes and CKD.
van Norman M, Molony DA. van Norman M, et al. Ann Intern Med. 2023 May;176(5):JC50. doi: 10.7326/J23-0023. Epub 2023 May 2. Ann Intern Med. 2023. PMID: 37126811

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Diabetes Management in Chronic Kidney Disease: Synopsis of the KDIGO 2022 Clinical Practice Guideline Update

Affiliations

Diabetes Management in Chronic Kidney Disease: Synopsis of the KDIGO 2022 Clinical Practice Guideline Update

Authors

Affiliations

Abstract

Comment in

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Substances

LinkOut - more resources

Full Text Sources

Medical

Research Materials