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Review
. 2025 Jan;19(1):217-245.
doi: 10.1177/19322968241292041. Epub 2024 Nov 29.

Consensus Report on the Use of Continuous Glucose Monitoring in Chronic Kidney Disease and Diabetes

Connie M Rhee  1   2 , Roma Y Gianchandani  2 , David Kerr  3 , Athena Philis-Tsimikas  4 , Csaba P Kovesdy  5 , Robert C Stanton  6 , Andjela T Drincic  7 , Rodolfo J Galindo  8 , Kamyar Kalantar-Zadeh  9 , Joshua J Neumiller  10 , Ian H de Boer  11 , Marcus Lind  12 , Sun H Kim  13 , Alessandra T Ayers  14 , Cindy N Ho  14 , Rachel E Aaron  14 , Tiffany Tian  14 , David C Klonoff  15
Affiliations
Review

Consensus Report on the Use of Continuous Glucose Monitoring in Chronic Kidney Disease and Diabetes

Connie M Rhee et al. J Diabetes Sci Technol. 2025 Jan.

Abstract

This report represents the conclusions of 15 experts in nephrology and endocrinology, based on their knowledge of key studies and evidence in the field, on the role of continuous glucose monitors (CGMs) in patients with diabetes and chronic kidney disease (CKD), including those receiving dialysis. The experts discussed issues related to CGM accuracy, indications, education, clinical outcomes, quality of life, research gaps, and barriers to dissemination. Three main goals of management for patients with CKD and diabetes were identified: (1) greater use of CGMs for better glycemic monitoring and management, (2) further research evaluating the accuracy, feasibility, outcomes, and potential value of CGMs in patients with end-stage kidney disease (ESKD) on hemodialysis, and (3) equitable access to CGM technology for patients with CKD. The experts also developed 15 conclusions regarding the use of CGMs in this population related to CGMs' unique delivery of both real-time information that can guide monitoring and management of glycemia and continuous and predictive data in this population, which is at higher risk for hypoglycemia and hyperglycemia. The group noted three major clinical gaps: (1) CGMs are not routinely prescribed for patients with diabetes and CKD; (2) CGMs are not approved by the United States Food and Drug Administration (FDA) for patients with diabetes who are on dialysis; and (3) CGMs are not routinely available to all of those who need them because of structural barriers in the health care system. These gaps can be improved with greater stakeholder collaboration, education, and awareness brought to the use of CGM technology in CKD.

Keywords: chronic kidney disease; continuous glucose monitor; diabetes; diabetic kidney disease; dialysis; end-stage kidney disease.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: C.M.R. has received honoraria and/or grant support from AstraZeneca, Dexcom, Fresenius, and Vifor. R.Y.G. has nothing to disclose. D.K. has received research support from Abbott Diabetes Care and has been a Consultant to Sanofi, Better Therapeutics, Perfood, and Abbott Diagnostics. A.P.-T. provides consulting and research services to Novo Nordisk, Lilly, Bayer, Dexcom, and Medtronic on behalf of her employer but receives no direct or indirect reimbursement for the services. C.P.K. received consulting feels from Astra Zeneca, Bayer, Boehringer, Ingelheim, Cara Therapeutics, Pharmacosmos, ProKidney, Renibus, and Takeda. R.C.S. has nothing to disclose. A.T.D. has nothing to disclose. R.J.G. has received research support from Novo Nordisk, Dexcom, Boehringer, and Eli Lilly and consulting/advisory/honoraria fees from Abbott, Aztra Zeneca, Bayer, Boehringer, Dexcom, Eli Lilly, Novo Nordisk and Medtronic. R.J.G. is partially supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH) under Award Numbers P30DK111024 (R.J.G.), K23DK123384 (R.J.G.). and R03DK138255-01. K.K.-Z. has received funding from the NIH to examine CGM in patients with CKD. J.J.N. is partially supported by NIH research grant OT2OD032581 and reports personal fees and other support from Bayer AG, Sanofi, Novo Nordisk, Boehringer Ingelheim, Eli Lilly, Proteomics International, and Dexcom outside the submitted work. I.H.d.B. consults for Alnylam, Boehringer Ingelheim, Lilly, Miter, and Novo Nordisk. I.H.D.B. has also received equipment and supplies for research donated to his institution from Dexcom and Novo Nordisk Research, and funding to his institution from NIDDK and Breakthrough T1D. M.L. has been a consultant or received honoraria from Astra Zeneca, Boehringer Ingelheim, Eli Lilly, Nordic InfuCare, and Novo Nordisk, and has received research grants from Eli Lilly and Novo Nordisk, all outside of the submitted work. S.H.K. reports a relationship with Morphic Medical that includes consulting or advisory. S.H.K. is partially supported by P30DK116074. A.T.A. is a consultant for Liom. C.N.H. is a consultant for Liom. R.E.A. has nothing to disclose. T.T. has nothing to disclose. D.C.K. is a consultant for Afon, embecta, Glucotrack, Lifecare, Novo, Samsung, SynchNeuro, and Thirdwayv.

Figures

Figure 1.
Figure 1.
A multifaceted and multidisciplinary approach to DKD management that includes adequate glycemic control and monitoring, which are a key cornerstone. Abbreviation: CV, cardiovascular.
Figure 2.
Figure 2.
Estimated annual percentage change in age-standardized incidence rates of diabetic kidney disease between 1990 and 2017. Figure reproduced from Li et al under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/License). Abbreviations: ASIR, age-standardized incidence rate; EAPC, estimated annual percent change.
Figure 3.
Figure 3.
Risk factors for hypoglycemia and hyperglycemia in chronic kidney disease. Figure modified from Rhee et al. Abbreviations: DM, diabetes mellitus; HD, hemodialysis; PD, peritoneal dialysis; PEW, protein-energy wasting; PTH, parathyroid hormone.
Figure 4.
Figure 4.
Strengths and limitations of existing glycemic metrics in advanced CKD and ESKD patients. Figure reproduced from Narasaki et al.
Figure 5.
Figure 5.
Risk factors for kidney transplant patients for developing post-transplant diabetes, including risk factors shared with diabetes in non-transplant patients and risk factors specific to kidney transplantation. Abbreviations: DDKT, deceased donor kidney transplantation; HLA, human leukocyte antigen; mTOR, mammalian target of rapamycin.
Figure 6.
Figure 6.
Bland-Altman Plot. A: All individual measurements FreeStyle Libre vs HemoCue; B: All individual measurements Dexcom G5 vs HemoCue. Thick dotted line represents the mean difference. Figure reproduced from Ólafsdóttir et al. under the under the CC BY-NC license (https://creativecommons.org/licenses/by-nc/4.0/)
Figure 7.
Figure 7.
Continuous glucose monitoring metrics in the assessment of glycemia in moderate-to-advanced CKD (in stages 3b, 4, and 5) in diabetes. Figure reproduced from Ling et al under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Abbreviations: GMI, glucose management indicator; G3b, stage 3b chronic kidney disease; G4, stage 4 chronic kidney disease; G5, stage 5 chronic kidney disease; HbA1c, hemoglobin A1c.
Figure 8.
Figure 8.
Future directions for research on CGM use in patients with CKD/ESKD, including clinical use, randomized clinical trials, economic benefits, and patient benefits. Abbreviations: CGM, continuous glucose monitor; CKD, chronic kidney disease; ESKD, end-stage kidney disease.
Figure 9.
Figure 9.
Barriers to widespread use of CGMs. Abbreviations: CGM, continuous glucose monitor; CKD, chronic kidney disease; DME, durable medical equipment; EMR, electronic medical record.
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