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KDIGO updates guidance on managing diabetes in people with CKD

A comprehensive, layered approach to the care of people with diabetes and CKD is advocated in the updated KDIGO guidance.

The KDIGO (Kidney Disease: Improving Global Outcomes) Work Group has published the Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease, as an update to its 2020 guideline. The group again used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to examine evidence and rate the strength of recommendations, and expert judgement to develop practice points by consensus.

The update includes 13 recommendations and 52 practice points for clinicians caring for people with diabetes and chronic kidney disease (CKD). With new therapies that can reduce the progression of CKD (and reduce the burden of cardiovascular disease), there is an emphasis on preserving kidney function and maintaining wellbeing, rather than replacing kidney function.

A comprehensive, tiered approach to the care of people with diabetes and CKD is advocated, with a foundation of lifestyle interventions and self-management, and first-line pharmacotherapy (such as SGLT2 inhibitors) demonstrated to improve clinical outcomes. Additional drugs with cardio- and renoprotection (such as GLP-1 RAs and non-steroidal mineralocorticoid RAs) are recommended as second-line therapy. The final tier comprises interventions to control additional risk factors, such as blood pressure, glycaemia and lipids.

A synopsis can be read here, while the full guidance is available here.

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