Research Summary

New Guidelines for Treatment of CKD, Diabetes Emphasizes Comprehensive Care

Jessica Ganga

The emergence of high-quality patient care evidence motivated the Kidney Disease: Improving Global Outcomes (KDIGO) organization to update its 2020 Clinical Practice Guideline for Diabetes Management, which provides physicians with advice in treating patients with diabetes and chronic kidney disease (CKD). The new set of guidelines—published by the KDIGO Work Group—features 13 recommendations and 52 practice points for clinicians.

Although the KDIGO Work Group published their first clinical practice guidelines on diabetes management for those with CKD just a few years earlier, the authors noted in their new guidelines that a reexamination of the 2020 guideline was necessary because “a wealth of high-quality new information that has quickly become available.”

To evaluate the evidence, the KDIGO Work Group used the Grading of Recommendations Assessment, Development approach. The authors limited their literature searches to randomized controlled trials and conducted their search using each topic covered in the 2020 guidelines from December 2021. The searches were updated in February 2022 at the time of public review.

In the KDIGO Work Group clinical practice guideline, the authors made several recommendations, including:

  • the promotion of a layered approach to care, which starts with lifestyle interventions and first-line pharmacotherapy;
  • the introduction of renin-angiotensin system inhibitors, sodium–glucose cotransporter-2 inhibitors, mineralocorticoid receptor antagonist diuretics, and other antihypertensive medications to improve intrarenal hemodynamics;
  • noting that preserving kidney function should be the main focus of physicians rather than replacing the kidney’s function thus diminishing the burden of other conditions such as heart failure; and
  • the adoption of a team-based focus on care that focuses on risk evaluation and patient empowerment so the best quality of care is provided to the patient. 

“The Work Group aimed to generate an updated guideline that is both rigorously devoted to existing evidence and clinically useful,” the authors wrote. “The group made recommendations only when they were supported by high-quality evidence from a systematic review generated by the evidence review team.”



Navaneethan SD, Zoungas S, Caramori ML, et al. Diabetes management in chronic kidney disease: synopsis of the KDIGO 2022 Clinical Practice Guideline update. Ann Intern Med. Published online January 10, 2023. doi:10.7326/M22-2904