The ADA and the KDIGO organization have together spelled out broad agreement on how clinicians should now manage patients with diabetes and CKD in a new consensus report.
or ARB is important for all patients with diabetes, hypertension, and albuminuria, titrated to maximum doses.
Statin treatment is necessary for all people with diabetes and CKD at moderate or high intensity depending on other clinical features., CKD, and an eGFR of at least 30 mL/min/1.73mThe panel also recommends treatment with an SGLT2 inhibitor with proven renal or cardiovascular benefits for all patients with type 2 diabetes, CKD, and an eGFR of at least 20 mL/min/1.73m. The report advises continued treatment with an SGLT2 inhibitor once started even if a patient's eGFR dips below this minimum.
The report puts treatment with a GLP-1 agonist second-line for patients with type 2 diabetes and CKD who do not reach their glycemic target on metformin and an SGLT2 inhibitor, and for patients unable to use these classes of drugs first-line. It specifies using agents from the GLP-1 agonist class with proven cardiovascular benefit and notes most agents from the class are safe even in patients with eGFR levels below 15 mL/min/1.
The consensus report had no commercial funding; several members of the writing panel have reported commercial disclosures.
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