Executive summary of the KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease: an update based on rapidly emerging new evidence

Rossing, Peter; Caramori, M. L.; Chan, Juliana C.N.; al., et

doi:10.22141/2307-1257.11.4.2022.386

Cited by 28 publications

(57 citation statements)

References 22 publications

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“…The two systematic reviews suggested that compared with high-salt diet, low-salt diet (with a mean difference in sodium intake of 80 mEq/day) significantly reduces SBP of 4.9 mmHg and proteinuria of 0.39 g/day and albuminuria of 0.05 g/day [27]. Taken together, these data support current international recommendations of dietary salt restriction in individuals with diabetes with or without hypertension or evidence of kidney disease [9 ▪ ,10].…”

Section: Salt-restricted Dietsupporting

confidence: 55%

“…The International Society of Renal Nutrition and Metabolism advocates ‘kidney-friendly recipes’ with a ‘personalized nutrition’ care approach for patients with chronic kidney disease [7,8]. In the Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guidelines, lifestyle intervention was recommended as standard management practices in blood pressure and diabetes management in patients with chronic kidney disease [9 ▪ ,10].…”

Section: Introductionmentioning

confidence: 99%

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Physical activity and nutrition in chronic kidney disease

Wang

March

Burton

2023

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of reviewLifestyle intervention is considered a cornerstone in chronic kidney disease management and has been recommended in different international or regional clinical practice guidelines in chronic kidney disease. However, evidence was largely based on the general population. Here we summarized the latest evidence supporting lifestyle intervention in chronic kidney disease.Recent findingsBoth observational cohort studies as well as randomized controlled trials have demonstrated health benefits with more physical activity in chronic kidney disease. There are compelling observational data supporting different health and kidney benefits with a healthy dietary pattern rich in fruits and vegetables, whole grains, plant-based foods and low in salt, low in sugar, saturated fat, red meat and ultraprocessed foods, a plant-based diet or Mediterranean diet in chronic kidney disease population. Clinical and epidemiologic studies also showed that higher 24 h urine potassium excretion (as proxy of higher dietary potassium intake) may be associated with lower blood pressure, better kidney outcomes and lower mortality in chronic kidney disease population. Randomized controlled trials also suggested that salt substitutes improved blood pressure control, reduced all-cause death and cardiovascular event risk in the general population compared with regular salt.SummaryAccumulating evidence supports the current recommendation of encouraging physical activity and promoting a healthy dietary pattern in chronic kidney disease patients. Whether potassium needs restriction in chronic kidney disease diet requires further review. The safety versus benefits of salt substitutes in patients with moderate and advanced chronic kidney disease warrants further investigation.

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Section: Salt-restricted Dietsupporting

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Physical activity and nutrition in chronic kidney disease

Wang

March

Burton

2023

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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“…With the consistency of organ protective benefits across multiple large clinical trials, SGLT‐2 inhibitors should first and foremost, be considered as a standard of care for organ protection in at risk individuals with CKD and atherosclerotic heart disease regardless of diabetes status, and not just for their glucose lowering properties 22 . Indeed, various professional clinical guidelines have taken such a stance, with many recommending SGLT‐2 inhibitors as first‐line treatment in patients with type 2 diabetes mellitus and atherosclerotic heart disease, heart failure, DKD and CKD 27–30 …”

Section: Indications For Sglt‐2 Inhibitors Treatmentmentioning

confidence: 99%

Practical considerations for the use of SGLT‐2 inhibitors in the Asia–Pacific countries—An expert consensus statement

Liew,

Lydia,

Matawaran

et al. 2023

Nephrology

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Recent clinical studies have demonstrated the effectiveness of SGLT‐2 inhibitors in reducing the risks of cardiovascular and renal events in both patients with and without type 2 diabetes mellitus. Consequently, many international guidelines have begun advocating for the use of SGLT‐2 inhibitors for the purpose of organ protection rather than as simply a glucose‐lowering agent. However, despite the consistent clinical benefits and available strong guideline recommendations, the utilization of SGLT‐2 inhibitors have been unexpectedly low in many countries, a trend which is much more noticeable in low resource settings. Unfamiliarity with the recent focus in their organ protective role and clinical indications; concerns with potential adverse effects of SGLT‐2 inhibitors, including acute kidney injury, genitourinary infections, euglycemic ketoacidosis; and their safety profile in elderly populations have been identified as deterring factors to their more widespread use. This review serves as a practical guide to clinicians managing patients who could benefit from SGLT‐2 inhibitors treatment and instill greater confidence in the initiation of these drugs, with the aim of optimizing their utilization rates in high‐risk populations.

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“…Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are recommended as first-line therapy in patients with type 2 diabetes and CKD who have an eGFR ≥20 ml/min per 1.73 m 2 . 1,2 Although randomized controlled trials have shown the cardiovascular and renoprotective effects of SGLT2i in patients with diabetic kidney disease, 3,4 their uptake in routine clinical practice has been slow: Recent studies show that as few as 6% of patients with CKD and type 2 diabetes are currently prescribed SGLT2i in the United States. 5,6 This is especially concerning because these patients are at high risk for cardiovascular disease and kidney disease progression.…”

Section: Introductionmentioning

confidence: 99%