ADA/KDIGO Joint Consensus Released! 7 core recommendations for "diabetic nephropathy", sneak peek!

Introduction: When diabetes is combined with chronic kidney disease, how to manage it? The international consensus gives the latest recommendations on the use of "metformin, statin, SGLT2i, GLP-1RA, phenichlorone"!

Patients with diabetes and chronic kidney disease (CKD) are at high risk of renal failure, atherosclerotic cardiovascular disease, heart failure, and premature death
.
Recently, the "Diabetes Management in Chronic Kidney Disease: Joint Consensus Report of the American Diabetes Association (ADA) and the Global Organization for Improving Kidney Disease Prognosis (KDIGO)" jointly developed by two international authoritative organizations, the American Diabetes Association (ADA) and the Global Organization for Improving Kidney Disease Outcomes (KDIGO), was published in the journal DiabetesCare to guide clinical practice
.

The joint consensus proposes seven core recommendations that provide specific guidance for the use of renin-angiotensin system inhibitors, metformin, sodium-glucose co-transporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RA), and nonsteroidal mineralocorticoid receptor antagonists
.

The ADA/KDIGO Joint Consensus proposes 7 core recommendations

➤ All patients with type 1 diabetes (T1D) or type 2 diabetes (T2D) and chronic kidney disease (CKD) should receive a comprehensive treatment plan developed by healthcare professionals and patients and agreed upon by the patient to optimize nutrition, exercise, smoking cessation, and weight
.
Evidence-based pharmacotherapy to protect organ function and other treatments
selected to achieve appropriate targets for blood glucose, blood pressure, and lipids should be included.

➤ For patients with T1D/T2D with hypertension and proteinuria, ACEi or ARB is recommended and titrated to the maximum antihypertensive or the highest tolerated dose
.

➤ Statins are recommended for all T1D/T2D patients with CKD, and "moderate-intensity statins" for primary prevention of atherosclerotic cardiovascular disease (ASCVD); "High-intensity statins" are used for secondary prevention
in patients with confirmed ASCVD and multiple risk factors for ASCVD.

➤Metformin
is recommended for patients with T2D, CKD, eGFR≥ 30 mL/min/1.
73 m^2.
In the following patients, the dose of metformin should be reduced to 1000 mg per day: eGFR 30~44 mL/min/1.
73 m^2 patients and eGFR
45~59 mL/min/1.
73 m^2 patients at high risk of lactic acidosis.

➤ For patients with T2D, CKD, and eGFR≥20 mL/min/1.
73 m^2, sodium-glucose co-transporter 2 inhibitors (SGLT2i), which have been shown to have renal or cardiovascular benefits
, are recommended.
Once the SGLT2i is started, it can continue to be used
at lower eGFR levels.

➤ For patients with T2D and CKD, if their individualized glycaemic goals cannot be met using metformin and/or SGLT2i, or if these drugs cannot be used, glucagon-like peptide 1 receptor agonists, which have been shown to have cardiovascular benefits
, are recommended.

➤ For patients with T2D, eGFR≥25 mL/min/1.
73 m^2, normal potassium levels, and proteinuria (ACR≥30 mg/g) renin-angiotensin system (RAS) inhibitors that have reached the maximum tolerated dose, a nonsteroidal mineralocorticoid receptor antagonist (ns-MRA)
with proven renal and cardiovascular benefit is recommended.

Resources:

[1] 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; doi:10.
2337/dci22-0027.

[2] The American Diabetes Association and Kidney Disease: Improving Global Outcomes release a consensus report on diabetes management in chronic kidney disease.
https://kdigo.
org/news-release-ada-kdigo-release-joint-consensus-report-on-diabetes-management-in-ckd/.
Published Oct.
4, 2022.
Accessed Oct.
5, 2022.