KDIGO guidelines address diabetes management in CKD

  • Navaneethan SD & al.
  • Ann Intern Med
  • 10 Nov 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

Key recommendations  

  • Comprehensive care:
    • Initiate angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker in patients with diabetes, hypertension, and albuminuria, titrated to the highest approved tolerated dose.
    • Advise patients who use tobacco to quit.  
  • Glycemic monitoring and targets:
    • Use HbA1c to monitor glycemic control.
    • Individualize HbA1c target ranging from
  • Lifestyle interventions:
    • Maintain protein intake of 0.8 g/kg/day for those not on dialysis.
    • Sodium intake
    • Moderate-intensity physical activity for ≥150 minutes/week, or level compatible with cardiovascular and physical tolerance.
  • Antihyperglycemic therapies:
    • Treat patients with type 2 diabetes, CKD, and estimated glomerular filtration rate ≥30 mL/minute/1.73 m2 with metformin and sodium-glucose cotransporter-2 inhibitor (SGLT2i).
    • If glycemic targets are not achieved or if unable to use metformin/SGLT2i, initiate a long-acting glucagon-like peptide-1 receptor agonist.
  • Approaches to management—implement:
    • Structured self-management educational program.  
    • Team-based, integrated care focused on risk evaluation and patient empowerment.