Top Ten Things Every Clinician Should Know About the KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease

Authors:
Kara Olstad, PharmD
Gurminder Sanghera, BSc, PharmD
Darren Grabe, BS, PharmD

Reviewers:
Jennifer Clements, PharmD, BCPS, BCACP, BC-ADM, CDCES
Ha Phan, PharmD, BCACP, CDCES

Citation:
Kidney 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.

Introduction

Kidney Disease: Improving Global Outcomes (KDIGO) is a nonprofit organization tasked with evaluating clinical trial data and publishing evidence-based recommendations to manage kidney disease and its complications. Diabetes is an epidemic affecting 537 million people worldwide (in 2021), and its prevalence is expected to increase to 800 million by 2045! Many people (~40%) with diabetes will develop chronic kidney disease (CKD) which can necessitate kidney replacement therapy, increases other health risks, and significantly increases healthcare costs.¹

The resources provided by KDIGO are a source of guidance to clinicians managing patients with kidney disease. In 2020, KDIGO published a practice guideline related specifically to the management of CKD in patients with diabetes. Since 2020, the results from several landmark clinical trials have been released, prompting KDIGO to publish an updated report in 2022.  This is an atypical timeline for KDIGO which normally allows for a longer interval between guideline updates, but the importance of the new evidence and the rapid pace of development of treatment for patients with diabetes and CKD prompted the update.

The 2022 KDIGO update contains changes in medication recommendations and espouses a holistic, patient-centered approach to managing diabetes and CKD. The guidelines include many useful tables, dosing information, and graphics to assist with pharmacologic and non-pharmacologic treatment decisions.

Here are the top ten things every clinician should know about the KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. This list is in no specific order of importance and is intended to describe the most relevant changes for ambulatory care practitioners.