It’s well known that diabetes patients are at higher risk for developing chronic kidney disease (CKD). Research finds CKD is diagnosed in between 20-40% of patients with diabetes. 

The American Diabetes Association (ADA) has added a new section to their 2022 Standard of Care guidelines to assist clinicians in managing and preventing the presence of CKD and related complications in patients with diabetes. Learn more about what it addresses and why it’s important.* 

Why Did the ADA Add CKD Guidelines?

Diabetic CKD can manifest in patients with type 1 and type 2 diabetes. If untreated, CKD may progress to end-stage renal disease, requiring a patient to receive dialysis therapy or kidney transplantation. 

In addition, the presence of CKD in diabetes patients significantly increases their risk of cardiovascular events. They are also at higher risk of experiencing acute kidney injury compared to CKD patients without diabetes. 

By adding CKD guidelines in 2022, the ADA hopes to offer insights into the clinical data that support the recommendations and offer clinician support to help monitor and manage CKD in the diabetes population. 

“Based on some of the recent studies and new treatments that are available, a couple of things [became clear]. One, we know that chronic kidney disease continues to be a huge issue, and it’s underdiagnosed and under-treated. And second, we now have new treatments that can really lower the risk of chronic kidney disease and particularly the progression,” said Robert Gabbay, M.D., Ph.D., chief scientific and medical officer at the ADA, in an interview.

What Are the New Guidelines?

The ADA partnered with nephrologists to help create guidelines that will enable clinicians to prevent and manage CKD in diabetes patients. Some of the information and recommendations covered in this section include:

• Annual assessments of urinary albumin and estimated glomerular filtration rates in patients with type 1 diabetes with a disease duration of at least five years and in all patients with type 2 diabetes
• Refraining from discontinuation of renin-angiotensin system blockade for minor increases in serum creatinine in the absence of volume depletion
• Use of an ACE inhibitor or angiotensin receptor blocker for nonpregnant patients with diabetes and hypertension and modestly elevated urinary albumin-to-creatinine ratio
• Periodic monitor of serum creatinine and potassium levels for changes when patients are treated with ACE inhibitors, angiotensin receptor blockers, or diuretics
• Referral of patients to nephrologists if they have an estimated glomerular filtration rate of less than 30 mL/min/1.73m2
• Prompt referral to nephrologists when uncertain about the etiology of kidney disease, difficult management issues, and rapidly progressing kidney disease

To learn more, visit Section 11 of the 2022 ADA guidelines, where the entire section focuses on CKD and risk management for diabetes patients. 

*Jeremias, S. (2022c, February 1). New Section on Chronic Kidney Disease Risk Management Added to ADA Standard of Care Guidelines. AJMC. https://www.ajmc.com/view/new-section-on-chronic-kidney-disease-risk-management-added-to-ada-standard-of-care-guidelines