Diabetes Management in Chronic Kidney Disease

Publication Date: October 1, 2020
Last Updated: July 31, 2022

Recommendations

Comprehensive care in patients with diabetes and CKD

Renin–angiotensin system (RAS) blockade

We recommend that treatment with an angiotensin-converting enzyme inhibitor (ACEi) or an angiotensin II receptor blocker (ARB) be initiated in patients with diabetes, hypertension, and albuminuria, and that these medications be titrated to the highest approved dose that is tolerated. (Level 1, B)
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Smoking cessation

We recommend advising patients with diabetes and CKD who use tobacco to quit using tobacco products. (Level 1, D)
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Glycemic monitoring and targets in patients with diabetes and CKD

Glycemic monitoring

We recommend using hemoglobin A1c (HbA1c) to monitor glycemic control in patients with diabetes and CKD. (Level 1, C)
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Glycemic targets

We recommend an individualized HbA1c target ranging from <6.5% to <8.0% in patients with diabetes and CKD not treated with dialysis. (Level 1, C)
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Lifestyle interventions in patients with diabetes and CKD

Nutrition intake

We suggest maintaining a protein intake of 0.8 g protein/kg (weight)/d for those with diabetes and CKD not treated with dialysis. (Level 2, C)
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We suggest that sodium intake be <2 g of sodium per day (or <90 mmol of sodium per day, or <5 g of sodium chloride per day) in patients with diabetes and CKD. (Level 2, C)
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Physical activity

We recommend that patients with diabetes and CKD be advised to undertake moderate-intensity physical activity for a cumulative duration of at least 150 minutes per week, or to a level compatible with their cardiovascular and physical tolerance. (Level 1, D)
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Antihyperglycemic therapies in patients with type 2 diabetes (T2D) and CKD

Metformin

We recommend treating patients with T2D, CKD, and an eGFR ≥30 ml/min per 1.73 m2 with metformin. (Level 1, B)
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Sodium–glucose cotransporter-2 inhibitors (SGLT2i)

We recommend treating patients with T2D, CKD, and an eGFR ≥30 ml/min per 1.73 m2 with an SGLT2i. (Level 1, A)
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Glucagon-like peptide-1 receptor agonists (GLP-1 RA)

In patients with T2D and CKD who have not achieved individualized glycemic targets despite use of metformin and SGLT2i, or who are unable to use those medications, we recommend a long-acting GLP-1 RA. (Level 1, B)
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Approaches to management of patients with diabetes and CKD

Self-management education programs

We recommend that a structured self-management educational program be implemented for care of people with diabetes and CKD. (Level 1, C)
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Team-based integrated care

We suggest that policymakers and institutional decision-makers implement teambased, integrated care focused on risk evaluation and patient empowerment to provide comprehensive care in patients with diabetes and CKD. (Level 2, B)
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Recommendation Grading

Abbreviations

  • CKD: Chronic Kidney Disease
  • HbA1C: Hemoglobin A1C
  • KDIGO: Kidney Disease: Improving Global Outcomes

Overview

Title

Diabetes Management in Chronic Kidney Disease

Authoring Organizations

Publication Month/Year

October 1, 2020

Last Updated Month/Year

February 6, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

It is intended to assist the practitioner caring for patients with diabetes and CKD

Target Patient Population

Patients with diabetes and CKD

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Long term care, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Prevention, Management, Treatment

Diseases/Conditions (MeSH)

D050171 - Dyslipidemias, D003920 - Diabetes Mellitus, D003922 - Diabetes Mellitus, Type 1, D003924 - Diabetes Mellitus, Type 2, D007676 - Kidney Failure, Chronic, D007674 - Kidney Diseases

Keywords

diabetes, chronic kidney disease, diabetes mellitus

Source Citation

Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney Int. 2020 Oct;98(4S):S1-S115. doi: 10.1016/j.kint.2020.06.019. PMID: 32998798.

Methodology

Number of Source Documents
468
Literature Search Start Date
October 18, 2018
Literature Search End Date
February 1, 2020