KDIGO Clinical Practice Guideline on Diabetes Management in Chronic Kidney Disease
The KDIGO Clinical Practice Guideline on Diabetes Management in Chronic Kidney Disease provides evidence-based, GRADE-rated recommendations covering comprehensive care, glycaemic targets, lifestyle, and antihyperglycaemic therapies, centred on organ-protective agents such as SGLT2 inhibitors.
Background
This KDIGO guideline addresses the large population of patients with diabetes and chronic kidney disease who face high risk of adverse kidney and cardiovascular outcomes. It was developed at a time when advances in diabetes therapeutics, particularly SGLT2 inhibitors and GLP-1 receptor agonists, offered new organ-protective options, with the goal of integrating these with existing management strategies.
Key recommendations
The guideline covers comprehensive care needs, glycaemic monitoring and targets, lifestyle interventions, antihyperglycaemic therapies, and educational and integrated-care approaches. The Work Group used the GRADE approach to grade evidence and rate recommendation strength, supplementing graded recommendations with consensus practice points where evidence was insufficient. Recommendations emphasise a foundation of healthy lifestyle and self-management with first-line pharmacotherapy proven to improve clinical outcomes, layered with additional agents that confer cardiovascular and kidney protection.
Clinical implications
The guideline underwent open public review and incorporated input from stakeholders and subject-matter experts before finalisation. By clarifying glycaemic targets and the use of specific antihyperglycaemic agents in diabetes and CKD, it gives clinicians actionable guidance to optimise care, with emphasis on shared decision-making, individualised goals, and a team-based, multidisciplinary approach.
Category
KDIGO
Source
KDIGO
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