KDOQI US Commentary on the KDIGO 2020 Clinical Practice Guideline for Diabetes Management in CKD - PubMed (original) (raw)

KDOQI US Commentary on the KDIGO 2020 Clinical Practice Guideline for Diabetes Management in CKD

Amy K Mottl et al. Am J Kidney Dis. 2022 Apr.

Abstract

In October 2020, KDIGO (Kidney Disease: Improving Global Outcomes) published its first clinical practice guideline directed specifically to the care of patients with diabetes and chronic kidney disease (CKD). This commentary presents the views of the KDOQI (Kidney Disease Outcomes Quality Initiative) work group for diabetes in CKD, convened by the National Kidney Foundation to provide an independent expert perspective on the new guideline. The KDOQI work group believes that the KDIGO guideline takes a major step forward in clarifying glycemic targets and use of specific antihyperglycemic agents in diabetes and CKD. The purpose of this commentary is to carry forward the conversation regarding optimization of care for patients with diabetes and CKD. Recent developments for prevention of CKD progression and cardiovascular events in people with diabetes and CKD, particularly related to sodium/glucose cotransporter 2 (SGLT2) inhibitors, have filled a longstanding gap in nephrology's approach to the care of persons with diabetes and CKD. The multifaceted benefits of SGLT2 inhibitors have facilitated interactions between nephrology, cardiology, endocrinology, and primary care, underscoring the need for innovative approaches to multidisciplinary care in these patients. We now have more interventions to slow kidney disease progression and prevent or delay kidney failure in patients with diabetes and kidney disease, but methods to streamline their implementation and overcome barriers in access to care, particularly cost, are essential to ensuring all patients may benefit.

Keywords: Diabetes; SGLT2 inhibitors; blood pressure control; chronic kidney disease (CKD); commentary; evidence-based recommendation; glucagon-like peptide 1 receptor agonists; glycemic targets; guideline implementation; guidelines; metformin; nephrology best practices; physical activity; protein intake; smoking; sodium intake.

Copyright © 2021 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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Figures

Figure 1.

Figure 1.

Schematic for comprehensive care of the patient with type 2 diabetes and CKD. Recommendations from KDIGO (Kidney Disease: Improving Global Outcomes) are represented in orange. Practice points from KDIGO are represented in blue. Asterisk refers to recommendations not specifically addressed by the original schematic in the KDIGO guidelines but deemed important worthy of inclusion by the KDOQI work group. Abbreviations: CKD, chronic kidney disease; HTN, hypertension; GLP-1 RA, glucagon-like peptide 1 receptor agonist; RAS, renin-angiotensin system; MRA, mineralocorticoid receptor antagonist; SGLT2, sodium/glucose transporter 2; UACR, urinary albumin-creatinine ratio; eGFR, estimated glomerular filtration rate; BP, blood pressure.

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