From the Guidelines
The KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease should be followed for the management of patients with diabetes and CKD, as it provides the most recent and highest quality evidence-based recommendations. The guideline targets a broad audience of clinicians treating diabetes and CKD, and includes updated recommendations on comprehensive care, glucose-lowering therapies, and approaches to management 1. The development of this guideline update followed an explicit process of evidence review and appraisal, using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to evaluate the quality of the evidence and the strength of recommendations. Key areas of focus include:
- Comprehensive care in patients with diabetes and CKD
- Glucose-lowering therapies in patients with type 2 diabetes (T2D) and CKD
- Glycemic monitoring and targets in patients with diabetes and CKD
- Lifestyle interventions in patients with diabetes and CKD
- Approaches to management of patients with diabetes and CKD. The guideline emphasizes the importance of a comprehensive approach to kidney disease management, addressing modifiable risk factors to slow progression and reduce cardiovascular complications, which are the leading cause of death in CKD patients 1. Limitations of the evidence are discussed, and areas for future research are presented, highlighting the need for ongoing evaluation and improvement of diabetes management in CKD patients 1. Overall, the KDIGO 2022 guideline provides a valuable resource for clinicians and patients, offering actionable recommendations and infographics based on the latest evidence, and should be used to guide clinical practice in the management of patients with diabetes and CKD.
From the Research
KDIGO Guideline Overview
- The KDIGO (Kidney Disease: Improving Global Outcomes) guideline provides a framework for the management of chronic kidney disease (CKD) [@[no reference available]@]
- However, based on available studies, the use of angiotensin-converting enzyme inhibitors (ACEis) and angiotensin-receptor blockers (ARBs) is recommended for patients with CKD to slow disease progression [@[1@, 2,3,4,5]
ACE Inhibitors and ARBs in CKD Management
- ACEis and ARBs have been shown to reduce proteinuria and slow the progression of CKD [@[1@, 2,3]
- Combination therapy with ACEis and ARBs may provide additional renoprotective benefits [@[3@]
- ACEis or ARBs reduce kidney failure compared to placebo or non-RAAS inhibitors in advanced CKD [@[4@]
Clinical Outcomes with ACEis and ARBs
- Exposure to ACEis or ARBs after acute kidney injury (AKI) is associated with lower risks of all-cause mortality, recurrent AKI, and progression to incident CKD [@[5@]
- Continued use of ACEis or ARBs after AKI may have a survival benefit, but close monitoring is needed due to the increased risk of hyperkalemia [@[5@]
Key Considerations
- The use of ACEis and ARBs in CKD management should be individualized based on patient characteristics and disease severity [@[2@, 3,4,5]
- Regular monitoring of kidney function, proteinuria, and electrolytes is essential to optimize treatment and minimize potential adverse effects [@[1@, 2,3,4,5]