KDIGO diabetes management in CKD guideline 2024
The KDIGO clinical practice guideline for diabetes management in CKD recommends a layered approach built on lifestyle and first-line SGLT2 inhibitor and RAAS-inhibitor therapy, adding GLP-1 receptor agonists and nonsteroidal mineralocorticoid receptor antagonists for additional heart and kidney protection.
Background
People with diabetes and chronic kidney disease are at high risk of kidney failure, atherosclerotic cardiovascular disease, heart failure, and premature mortality. KDIGO developed and subsequently updated its clinical practice guideline for diabetes management in CKD to integrate rapidly emerging trial evidence, using systematic evidence review and the GRADE approach to grade recommendations supplemented by expert practice points.
Key recommendations
The guideline recommends comprehensive, layered care starting with lifestyle interventions and self-management, with first-line pharmacotherapy that includes renin-angiotensin system inhibitors for blood pressure and proteinuria and SGLT2 inhibitors demonstrated to improve clinical outcomes. Additional agents with proven heart and kidney protection — GLP-1 receptor agonists and a nonsteroidal mineralocorticoid receptor antagonist (finerenone) — are layered on, alongside control of blood pressure, glycaemia, and lipids. The updated version contains 13 recommendations and 52 practice points, with new evidence concentrated in the chapters on comprehensive care and glucose-lowering therapies.
Clinical implications
The guideline emphasises preserving kidney function and patient well-being through individualised, team-based, and integrated care with shared decision-making. By aligning glycaemic targets with organ-protective pharmacotherapy, it provides clinicians a clear framework for combining lifestyle measures and proven drug classes to reduce CKD progression and cardiovascular events in patients with diabetes.
Category
KDIGO
Source
KDIGO
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