Navaneethan SD, Zoungas S, Caramori ML, et al. Diabetes Management in Chronic Kidney Disease: Synopsis of the KDIGO 2022 Clinical Practice Guideline Update. Ann Intern Med. 2023 Jan 10. doi: 10.7326/M22-2904. (Evidence-based guideline)

DESCRIPTION: The KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease is an update of the 2020 guideline from Kidney Disease: Improving Global Outcomes (KDIGO).

METHODS: The KDIGO Work Group updated the guideline, which included reviewing and grading new evidence that was identified and summarized. As in the previous guideline, the Work Group used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to appraise evidence and rate the strength of recommendations and expert judgment to develop consensus practice points. New evidence led to updating of recommendations in the chapters Comprehensive Care in Patients With Diabetes and CKD (Chapter 1) and Glucose-Lowering Therapies in Patients With T2D and CKD (Chapter 4). New evidence did not change recommendations in the chapters Glycemic Monitoring and Targets in Patients With Diabetes and CKD (Chapter 2), Lifestyle Interventions in Patients With Diabetes and CKD (Chapter 3), and Approaches to Management of Patients With Diabetes and CKD (Chapter 5).

RECOMMENDATIONS: The updated guideline includes 13 recommendations and 52 practice points for clinicians caring for patients with diabetes and chronic kidney disease (CKD). A focus on preserving kidney function and maintaining well-being is recommended using a layered approach to care, starting with a foundation of lifestyle interventions, self-management, and first-line pharmacotherapy (such as sodium-glucose cotransporter-2 inhibitors) demonstrated to improve clinical outcomes. To this are added additional drugs with heart and kidney protection, such as glucagon-like peptide-1 receptor agonists and nonsteroidal mineralocorticoid receptor antagonists, and interventions to control risk factors for CKD progression and cardiovascular events, such as blood pressure, glycemia, and lipids.

Discipline Area Score
Family Medicine (FM)/General Practice (GP) 7 / 7
General Internal Medicine-Primary Care(US) 7 / 7
Endocrine 6 / 7
Nephrology 6 / 7
Pediatrics (General) 6 / 7
Internal Medicine 6 / 7
Comments from MORE raters

Endocrine rater

Useful guidelines for nephrologists that closely mirror clinical practice guidelines for diabetes management that were published in the past 2-3 years.

Endocrine rater

As an endocrinologist, I appreciate the joint efforts of multiple subspecialists to treat the whole patient and not just the plasma glucose level. This is a great advance.

Internal Medicine rater

Updated KIGO guideline.

Internal Medicine rater

Useful packaging of available evidence, but very limited incorporation of cost-effectiveness data.

Nephrology rater

This is a nice concise summary of the extensive KDIGO practice guidelines for diabetic nephropathy. This is broadly applicable to any clinical nephrologist and to many general internists. The figures and schema are well done and useful. Overall, a very high-yield summary.

Nephrology rater

An informative paper.

Pediatrics (General) rater

The new KDIGO Guidelines incorporate the newest therapeutic management in diabetes, chronic kidney disease, and heart disease prevention. These guidelines may not be directly relevant to young children, but are definitely helpful in transitioning pediatric patients to adulthood.
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