Executive summary of the 2020 KDIGO Diabetes Management in CKD Guideline: evidence-based advances in monitoring and treatment

Ian H de Boer; M Luiza Caramori; Juliana C N Chan; Hiddo J L Heerspink; Clint Hurst; Kamlesh Khunti; Adrian Liew; Erin D Michos; Sankar D Navaneethan; Wasiu A Olowu; Tami Sadusky; Nikhil Tandon; Katherine R Tuttle; Christoph Wanner; Katy G Wilkens; Sophia Zoungas; Lyubov Lytvyn; Jonathan C Craig; David J Tunnicliffe; Martin Howell; Marcello Tonelli; Michael Cheung; Amy Earley; Peter Rossing

doi:10.1016/j.kint.2020.06.024

Executive summary of the 2020 KDIGO Diabetes Management in CKD Guideline: evidence-based advances in monitoring and treatment

Kidney Int. 2020 Oct;98(4):839-848. doi: 10.1016/j.kint.2020.06.024. Epub 2020 Jul 10.

Authors

Ian H de Boer¹, M Luiza Caramori², Juliana C N Chan³, Hiddo J L Heerspink⁴, Clint Hurst⁵, Kamlesh Khunti⁶, Adrian Liew⁷, Erin D Michos⁸, Sankar D Navaneethan⁹, Wasiu A Olowu¹⁰, Tami Sadusky¹¹, Nikhil Tandon¹², Katherine R Tuttle¹³, Christoph Wanner¹⁴, Katy G Wilkens¹⁵, Sophia Zoungas¹⁶, Lyubov Lytvyn¹⁷, Jonathan C Craig¹⁸, David J Tunnicliffe¹⁹, Martin Howell¹⁹, Marcello Tonelli²⁰, Michael Cheung²¹, Amy Earley²¹, Peter Rossing²²

Affiliations

¹ Kidney Research Institute, University of Washington, Seattle, Washington, USA. Electronic address: deboer@u.washington.edu.
² University of Minnesota, Minneapolis, Minnesota, USA.
³ 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.
⁴ University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁵ Patient Representative, Houston, Texas, USA.
⁶ Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK.
⁷ Mount Elizabeth Novena Hospital, Singapore.
⁸ Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁹ Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.
¹⁰ Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, State of Osun, Nigeria.
¹¹ Patient Representative, Seattle, Washington, USA.
¹² Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.
¹³ University of Washington, Spokane, Washington, USA.
¹⁴ University Hospital of Würzburg, Würzburg, Germany.
¹⁵ Northwest Kidney Centers, Seattle, Washington, USA.
¹⁶ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
¹⁷ MAGIC Evidence Ecosystem Foundation and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
¹⁸ College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; Cochrane Kidney and Transplant, Sydney, New South Wales, Australia.
¹⁹ Cochrane Kidney and Transplant, Sydney, New South Wales, Australia; Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
²⁰ University of Calgary, Calgary, Alberta, Canada.
²¹ KDIGO, Brussels, Belgium.
²² Steno Diabetes Center Copenhagen and University of Copenhagen, Copenhagen, Denmark. Electronic address: peter.rossing@regionh.dk.

PMID: 32653403
DOI: 10.1016/j.kint.2020.06.024

Abstract

Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease represents the first KDIGO guideline on this subject. The guideline comes at a time when advances in diabetes technology and therapeutics offer new options to manage the large population of patients with diabetes and chronic kidney disease (CKD) at high risk of poor health outcomes. An enlarging base of high-quality evidence from randomized clinical trials is available to evaluate important new treatments offering organ protection, such as sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists. The goal of the new guideline is to provide evidence-based recommendations to optimize the clinical care of people with diabetes and CKD by integrating new options with existing management strategies. In addition, the guideline contains practice points to facilitate implementation when insufficient data are available to make well-justified recommendations or when additional guidance may be useful for clinical application. The guideline covers comprehensive care of patients with diabetes and CKD, glycemic monitoring and targets, lifestyle interventions, antihyperglycemic therapies, and self-management and health systems approaches to management of patients with diabetes and CKD.

Keywords: GLP-1 receptor agonist; HbA1c; KDIGO; SGLT2 inhibitor; angiotensin II receptor blocker; angiotensin-convering enzyme inhibitor; chronic kidney disease; dialysis; evidence-based; glycemia; glycemic monitoring; glycemic targets; guideline; hemodialysis; lifestyle; metformin; models of care; nutrition; renin-angiotensin system; self-management; systematic review; team-based care.

Publication types

Practice Guideline

MeSH terms

Diabetes Mellitus, Type 2* / complications
Diabetes Mellitus, Type 2* / diagnosis
Diabetes Mellitus, Type 2* / drug therapy
Humans
Hypoglycemic Agents / therapeutic use
Renal Insufficiency, Chronic* / diagnosis
Renal Insufficiency, Chronic* / therapy
Sodium-Glucose Transporter 2 Inhibitors*

Substances

Hypoglycemic Agents
Sodium-Glucose Transporter 2 Inhibitors