In October 2020, KDIGO (Kidney Disease: Improving Global Outcomes) published its first clinical practice guideline directed specifically to the care of patients with diabetes and chronic kidney disease (CKD). This commentary presents the views of the KDOQI (Kidney Disease Outcomes Quality Initiative) work group for diabetes in CKD, convened by the National Kidney Foundation to provide an independent expert perspective on the new guideline. The KDOQI work group believes that the KDIGO guideline takes a major step forward in clarifying glycemic targets and use of specific antihyperglycemic agents in diabetes and CKD. The purpose of this commentary is to carry forward the conversation regarding optimization of care for patients with diabetes and CKD. Recent developments for prevention of CKD progression and cardiovascular events in people with diabetes and CKD, particularly related to sodium/glucose cotransporter 2 (SGLT2) inhibitors, have filled a longstanding gap in nephrology's approach to the care of persons with diabetes and CKD. The multifaceted benefits of SGLT2 inhibitors have facilitated interactions between nephrology, cardiology, endocrinology, and primary care, underscoring the need for innovative approaches to multidisciplinary care in these patients. We now have more interventions to slow kidney disease progression and prevent or delay kidney failure in patients with diabetes and kidney disease, but methods to streamline their implementation and overcome barriers in access to care, particularly cost, are essential to ensuring all patients may benefit.
Bibliographical noteFunding Information:
Amy K. Mottl, MD, MPH, Radica Alicic, MD, Christos Argyropoulos, MD, Frank C. Brosius, MD, Michael Mauer, MD, Mark Molitch, MD, Robert G. Nelson, MD, PhD, Leigh Perreault, MD, and Susanne B. Nicholas, MD, MPH, PhD. No financial support was received for the development of this commentary. Dr Mottl has received consulting fees from Bayer and honoraria from UpToDate. Dr Agryropoulos has received consulting fees from Baxter and HSAG as well as research support from Dialysis Clinic Inc. Dr Mauer has received consulting fees from Novo Nordisk. Dr Molitch has received consulting fees from Merck, Pfizer, Tiburio, and VA hospitals as well as research grants from Bayer, Novartis, Chiasma, Crinetics, Strongbridge, and NIH. Dr Perreault has received honoraria from Novo Nordisk, Sanofi, Astra Zeneca, Boehringer Ingelheim, Eli Lilly, Merck, and Janssen. The remaining authors declare that they have no relevant financial interests. The authors thank Dr Meda Pavkov for her substantive review and edits to this work. The authors also thank Debra Taylor, Jessica Joseph, and the NKF for their assistance with the commentary. Guideline recommendations included in this article originally were published in Kidney International, are ©2020 KDIGO, and were reproduced with permission from KDIGO. Received September 14, 2021, following review and approval by the NKF Scientific Advisory Board (membership listed at kidney.org/about/sab; as AJKD Editor-in-Chief, Dr Feldman was recused) and KDOQI Chair and Vice Chairs (listed at kidney.org/professionals/guidelines/leadership). Accepted September 15, 2021, after editorial review by a Deputy Editor.
© 2021 National Kidney Foundation, Inc.
- SGLT2 inhibitors
- blood pressure control
- chronic kidney disease (CKD)
- evidence-based recommendation
- glucagon-like peptide 1 receptor agonists
- glycemic targets
- guideline implementation
- nephrology best practices
- physical activity
- protein intake
- sodium intake
PubMed: MeSH publication types
- Journal Article