Summary
A recent joint consensus report from the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO)1 aligns guideline recommendations2,3 for chronic kidney disease (CKD) in people with diabetes. The report aims to provide clear guidance on the screening, monitoring, and treatment for people with diabetes and CKD with the goal of slowing disease progression and improving clinical outcomes through early intervention. Although separate guidelines released by ADA2 and KDIGO3 in 2022 differed slightly (Table 1), this consensus report highlights agreement in priority areas for care of this population.
An estimated 40% of people with diabetes develop CKD in their lifetime,4 which increases the risk for atherosclerotic cardiovascular disease, heart failure, cardiovascular death, and all-cause mortality.5 Diabetes and CKD have a disproportionate impact on racial and ethnic minorities and older adults.
CKD is defined as eGFR 2 or albuminuria (ACR ≥ 30mg/g) that persists for at least three months (Figure 1). Screening for CKD is recommended annually as part of care for people with diabetes. In type 2 diabetes, screening should begin at the time of diagnosis, while for type 1 diabetes, screening should begin five years after diagnosis. Referral and treatment recommendations, based on degree of CKD and risk of progression, are found in Figure 2. Figure 3 illustrates an algorithm for therapies based on evidence of benefit in people with diabetes. Comprehensive care of people with diabetes who also have CKD is recommended, including education to promote self-management, and optimization of nutrition, exercise, and smoking cessation programs.
Sources
1de Boer IH, Khunti K, Sadusky T, et al. Diabetes management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO). Diabetes Care. 2022;45(12):3075-3090. doi:10.2337/dci22-0027.
2American Diabetes Association. Standards of Medical Care in Diabetes—2022. Diabetes Care. 2022;45(Suppl.1):S1-S264.
3Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney Int. 2022;102(5S):S1-S127. doi:10.1016/j.kint.2022.06.008.
4Afkarian M, Zelnick LR, Hall YN, et al. Clinical manifestations of kidney disease among US adults with diabetes, 1988-2014. JAMA. 2016;316(6):602-610. doi:10.1001/jama.2016.10924.
5Afkarian M, Sachs MC, Kestenbaum B, et al. Kidney disease and increased mortality risk in type 2 diabetes. J Am Soc Nephrol. 2013;24(2):302-308. doi:10.1681/ASN.2012070718.