Executive summary of the KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease: an update based on rapidly emerging new evidence

Peter Rossing; 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; Jonathan C Craig; David J Tunnicliffe; Marcello A Tonelli; Michael Cheung; Amy Earley; Ian H de Boer

doi:10.1016/j.kint.2022.06.013

Executive summary of the KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease: an update based on rapidly emerging new evidence

Kidney Int. 2022 Nov;102(5):990-999. doi: 10.1016/j.kint.2022.06.013.

Authors

Peter Rossing¹, 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, Jonathan C Craig¹⁷, David J Tunnicliffe¹⁸, Marcello A Tonelli¹⁹, Michael Cheung²⁰, Amy Earley²⁰, Ian H de Boer²¹

Affiliations

¹ Steno Diabetes Center Copenhagen, Copenhagen, Denmark; University of Copenhagen, Copenhagen, Denmark. Electronic address: peter.rossing@regionh.dk.
² Division of Diabetes, Endocrinology and Metabolism, University of Minnesota, Minneapolis, Minnesota, USA.
³ Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Hong Kong, China; Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China.
⁴ Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
⁵ Houston, Texas, USA.
⁶ Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK.
⁷ The Kidney & Transplant Practice, Mount Elizabeth Novena Hospital, Singapore.
⁸ Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁹ Section of Nephrology, Department of Medicine, Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas, USA; Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.
¹⁰ Pediatric Nephrology and Hypertension Unit, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, State of Osun, Nigeria.
¹¹ Seattle, Washington, USA.
¹² Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.
¹³ Division of Nephrology, University of Washington, Spokane, Washington, USA.
¹⁴ Division of Nephrology, University Hospital of Würzburg, Würzburg, Germany.
¹⁵ Nutrition and Fitness Services, Northwest Kidney Centers, Seattle, Washington, USA.
¹⁶ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
¹⁷ College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; Cochrane Kidney and Transplant, Sydney, New South Wales, Australia.
¹⁸ Cochrane Kidney and Transplant, Sydney, New South Wales, Australia; Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
¹⁹ Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
²⁰ KDIGO, Brussels, Belgium.
²¹ Kidney Research Institute, University of Washington, Seattle, Washington, USA. Electronic address: deboer@u.washington.edu.

PMID: 36272755
DOI: 10.1016/j.kint.2022.06.013

Abstract

The Kidney Disease: Improving Global Outcomes (KDIGO) 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (CKD) represents a focused update of the KDIGO 2020 guideline on the topic. The guideline targets a broad audience of clinicians treating people with diabetes and CKD. Topic areas for which recommendations are updated based on new evidence include Chapter 1: Comprehensive care in patients with diabetes and CKD and Chapter 4: Glucose-lowering therapies in patients with type 2 diabetes (T2D) and CKD. The content of previous chapters on 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) has been deemed current and was not changed. This guideline update was developed according to an explicit process of evidence review and appraisal. Treatment approaches and guideline recommendations are based on systematic reviews of relevant studies and appraisal of the quality of the evidence, and the strength of recommendations followed the "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) approach. Limitations of the evidence are discussed, and areas for which additional research is needed are presented.

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

Publication types

Practice Guideline
Research Support, Non-U.S. Gov't

MeSH terms

Diabetes Mellitus, Type 2* / complications
Diabetes Mellitus, Type 2* / diagnosis
Diabetes Mellitus, Type 2* / therapy
Glucose
Humans
Renal Insufficiency, Chronic* / complications
Renal Insufficiency, Chronic* / diagnosis
Renal Insufficiency, Chronic* / therapy

Substances

Glucose