What is KDIGO (Kidney Disease: Improving Global Outcomes)?

What is KDIGO?

KDIGO (Kidney Disease: Improving Global Outcomes) is an independent, international nonprofit foundation established in 2003 with the mission to improve care and outcomes for kidney disease patients worldwide through the development, coordination, and implementation of evidence-based clinical practice guidelines. 1

Organizational Structure and Mission

• KDIGO operates as an independently incorporated nonprofit foundation governed by an international board of directors 1, 2
• The organization's core mission is to promote coordination, collaboration, and integration of initiatives to develop and implement clinical practice guidelines for kidney disease patients globally 1
• The rationale for a global approach stems from mounting evidence that kidney disease is common worldwide and its complications are universal, making science-based care independent of geographical location 1

Guideline Development Process

• KDIGO convenes international, multidisciplinary Work Groups consisting of nephrologists, specialists from other fields, epidemiologists, primary care practitioners, dietitians, and patient representatives 1
• The organization collaborates with professional evidence review teams (such as the Cochrane Kidney and Transplant Evidence Review Team and Tufts Center for Kidney Disease Guideline Development) to conduct systematic reviews 1
• All guidelines use the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology to appraise evidence quality and rate recommendation strength 1, 2
• Each guideline undergoes rigorous public review involving stakeholders, subject matter experts, industry representatives, and national organizations before finalization 1

Scope of Clinical Practice Guidelines

KDIGO has developed comprehensive guidelines covering major aspects of kidney disease care, including:

• Chronic kidney disease evaluation and management - providing guidance on definition, classification, monitoring, and treatment of CKD in adults and children not receiving renal replacement therapy 1
• Diabetes management in CKD - addressing comprehensive care, glycemic monitoring, lifestyle interventions, and antihyperglycemic therapies 1
• Lipid management - covering assessment and statin-based treatment for all CKD stages including dialysis and transplant recipients 1
• CKD-Mineral and Bone Disorder (CKD-MBD) - addressing diagnosis, evaluation, prevention, and treatment of bone and mineral abnormalities 1
• Hepatitis C in CKD - providing guidance on prevention, diagnosis, evaluation, and treatment 1
• Kidney transplantation - covering evaluation and management of transplant candidates 3

Global Implementation Philosophy

• KDIGO guidelines are designed to provide evidence-based recommendations that represent ideal care if resources were unlimited 1
• The organization recognizes that resource availability varies globally and recommends "globalizing the evidence but localizing the decision" for adoption and implementation 1
• This approach aligns with WHO Guidelines on Guidelines, allowing regional Guideline Development Groups to prioritize and adapt recommendations appropriate for their settings 1
• The target audience includes primary care physicians, nephrologists, specialists, nurses, pharmacists, dietitians, and other clinicians caring for kidney disease patients worldwide 1

Evolution and Updates

• KDIGO regularly updates guidelines based on new evidence, with the most recent 2024 CKD guideline representing a major update where only 6 statements from 2012 were retained unchanged 1
• The organization recognizes CKD as a global public health problem and incorporates advances in diagnostic evaluation, molecular diagnostics, and machine learning/artificial intelligence 1
• Guidelines include both graded recommendations (supported by systematic reviews) and ungraded practice points (directing clinical care where systematic review evidence is insufficient) 1