Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO)

Boer, Ian de; Khunti, Kamlesh; Sadusky, Tami; Tuttle, Katherine R.; Neumiller, Joshua J.; Rhee, Connie M.; Rosas, Sylvia E.; Persson, Frederik; Bakris, George L.

doi:10.2337/dci22-0027

Cited by 273 publications

(299 citation statements)

References 83 publications

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“…Figure 1 (parts i and ii) shows a clinical pathway for T2D and CKD and includes the classification of CKD, the risk of CKD progression, and cardiovascular risk that a clinician could talk through with their patient during a clinic visit [ 4 , 12 , 14 ]. The recommendations in the figure are based on the 2022 American Diabetes Association (ADA) treatment guidelines [ 12 ], the 2022 ADA/Kidney Disease Improving Global Outcomes (KDIGO)–consensus statement [ 14 ], and the 2020 KDIGO treatment guidelines [ 4 ]. The pathway discussion would provide information on the prevention of CKD as well as screening, monitoring, and staging of CKD.…”

Section: The Clinician Perspectivementioning

confidence: 99%

“…1 Proposed clinical care pathway for patients with T2D that could be discussed during a clinic visit. (i) Prevention, screening, and CKD progression control [ 12 , 14 ]. a No more than one alcoholic drink per day for adult women and no more than two drinks per day for adult men [ 12 ].…”

Section: The Clinician Perspectivementioning

confidence: 99%

“…To increase the quality of medical consultations to a more shared decision-making process, clinicians may consider asking patient-focused questions related to CKD to ensure their patient's understanding of the interventions and medications that are being used to prevent complications (Table 1). Additionally, clinicians should be prepared to answer questions their patient may ask about their T2D and CKD risks (Table 2) [4,5,7,[12][13][14][15][16][17][18][19]; the answers given should consider the patients' level of health literacy and be communicated in a clear and consistent way to ensure understanding and to promote effective dialogue. The responses from the patient coauthors suggest that in some instances there was ineffective communication by their HCPs.…”

Section: Shared Decision-makingmentioning

confidence: 99%

“…Checklists for HCPs and patients to navigate jointly may prompt discussion and can be visually appealing. Figure 1 (parts i and ii) shows a clinical pathway for T2D and CKD and includes the classification of CKD, the risk of CKD progression, and cardiovascular risk that a clinician could talk through with their patient during a clinic visit [4,12,14]. The recommendations in the figure are based on the 2022 American Diabetes Association (ADA) treatment guidelines [12], the 2022 ADA/Kidney Disease Improving Global Outcomes (KDIGO)-consensus statement [14], and the 2020 KDIGO treatment guidelines [4].…”

Section: Resourcesmentioning

confidence: 99%

“…The response guidance in the right-hand column of the table is directed to the HCP/clinician and should not be relayed to the patient verbatim, but instead communicated on the basis of the patient's level of health literacy. Points of note for the clinician/HCP in the example responses are in italics[4,5,7,[12][13][14][15][16][17][18][19] ACEi angiotensin-converting enzyme inhibitor, ARB angiotensin receptor blocker, CKD chronic kidney disease, DCCT Diabetes Control and Complications Trial, eGFR estimated glomerular filtration rate, SGLT-2 sodium-glucose cotransporter 2, UACR urine albumin-to-creatinine ratio, UKPDS UK…”

mentioning

confidence: 99%

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Living with Chronic Kidney Disease and Type 2 Diabetes Mellitus: The Patient and Clinician Perspective

et al. 2022

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Comorbid type 2 diabetes mellitus (T2D) and chronic kidney disease (CKD) is associated with poor health outcomes and a high economic burden. Management of these conditions remains a significant challenge for current healthcare systems. The objective of this article is to describe the experiences of patients living with T2D and CKD and their thoughts on how communication between patients and their clinicians could be improved despite the multiple comorbidities that need to be addressed. We present the individual perspectives of three patient authors, followed by relevant discussion around the management of CKD in patients with T2D by clinician authors. Audio abstract available for this article. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02325-9.

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Section: The Clinician Perspectivementioning

confidence: 99%

Section: The Clinician Perspectivementioning

confidence: 99%

Section: Shared Decision-makingmentioning

confidence: 99%

Section: Resourcesmentioning

confidence: 99%

mentioning

confidence: 99%

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Living with Chronic Kidney Disease and Type 2 Diabetes Mellitus: The Patient and Clinician Perspective

et al. 2022

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Electronic Health Record Population Health Management for Chronic Kidney Disease Care

Jhamb,

Weltman,

Devaraj

et al. 2024

JAMA Intern Med

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ImportanceLarge gaps in clinical care in patients with chronic kidney disease (CKD) lead to poor outcomes.ObjectiveTo compare the effectiveness of an electronic health record–based population health management intervention vs usual care for reducing CKD progression and improving evidence-based care in high-risk CKD.Design, Setting, and ParticipantsThe Kidney Coordinated Health Management Partnership (Kidney CHAMP) was a pragmatic cluster randomized clinical trial conducted between May 2019 and July 2022 in 101 primary care practices in Western Pennsylvania. It included patients aged 18 to 85 years with an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73m2 with high risk of CKD progression and no outpatient nephrology encounter within the previous 12 months.InterventionsMultifaceted intervention for CKD comanagement with primary care clinicians included a nephrology electronic consultation, pharmacist-led medication management, and CKD education for patients. The usual care group received CKD care from primary care clinicians as usual.Main Outcomes and MeasuresThe primary outcome was time to 40% or greater reduction in eGFR or end-stage kidney disease.ResultsAmong 1596 patients (754 intervention [47.2%]; 842 control [52.8%]) with a mean (SD) age of 74 (9) years, 928 (58%) were female, 127 (8%) were Black, 9 (0.6%) were Hispanic, and the mean (SD) estimated glomerular filtration rate was 36.8 (7.9) mL/min/1.73m2. Over a median follow-up of 17.0 months, there was no significant difference in rate of primary outcome between the 2 arms (adjusted hazard ratio, 0.96; 95% CI, 0.67-1.38; P = .82). Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker exposure was more frequent in intervention arm compared with the control group (rate ratio, 1.21; 95% CI, 1.02-1.43). There was no difference in the secondary outcomes of hypertension control and exposure to unsafe medications or adverse events between the arms. Several COVID-19–related issues contributed to null findings in the study.Conclusion and RelevanceIn this study, among patients with moderate-risk to high-risk CKD, a multifaceted electronic health record–based population health management intervention resulted in more exposure days to angiotensin-converting enzyme inhibitors/angiotensin receptor blockers but did not reduce risk of CKD progression or hypertension control vs usual care.Trial RegistrationClinicalTrials.gov Identifier: NCT03832595

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Use of SGLT2 Inhibitors vs GLP-1 RAs and Anemia in Patients With Diabetes and CKD

Hu,

Shao,

Tsai

et al. 2024

JAMA Netw Open

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ImportanceSodium-glucose cotransporter 2 (SGLT2) inhibitors are associated with lower anemia risk, based on findings from post hoc analyses of the CREDENCE and DAPA-CKD trials; however, the effectiveness of SGLT2 inhibitors in a more generalizable type 2 diabetes (T2D) and chronic kidney disease (CKD) population, with active comparisons pertinent to current practice, is unknown.ObjectiveTo evaluate and compare anemia incidence between SGLT2 inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) among patients with T2D and CKD stages 1 to 3.Design, Setting, and ParticipantsThis retrospective cohort study used target trial emulation of an expanded CREDENCE and DAPA-CKD study framework. The study was conducted among adults with T2D and CKD initiating SGLT2 inhibitors or GLP-1 RAs between January 1, 2016, and December 31, 2021, with follow-up until December 31, 2022. The study was conducted at the Chang Gung Medical Foundation, the largest multi-institutional hospital system in Taiwan.ExposuresInitiation of SGLT2 inhibitors or GLP-1 RAs.Main Outcomes and MeasuresThe primary outcome was a composite of anemia outcomes, including anemia event occurrence (hemoglobin level &lt;12-13 g/dL or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes) or anemia treatment initiation. Changes in hematological parameters, including hemoglobin level, hematocrit level, and red blood cell count, were evaluated during the follow-up period for as long as 3 years.ResultsThe cohort included a total of 13 799 patients with T2D and CKD, initiating SGLT2 inhibitors (12 331 patients; mean [SD] age, 62.4 [12.3] years; 7548 [61.2%] male) or GLP-1 RAs (1468 patients; mean [SD] age, 61.5 [13.3] years; 900 [61.3%] male). After the median follow-up period of 2.5 years, patients receiving SGLT2 inhibitors had lower incidence of composite anemia outcomes (hazard ratio [HR], 0.81; 95% CI, 0.73-0.90) compared with those receiving GLP-1 RAs. SGLT2 inhibitors were associated with a lower incidence of anemia events (HR, 0.79; 95% CI, 0.71-0.87) but not with a lower rate of anemia treatment initiation (HR, 0.99; 95% CI, 0.83-1.19). Changes in hematological parameters for SGLT2 inhibitors and GLP-1 RAs throughout the 3-year follow-up period supported the primary analyses.Conclusions and RelevanceIn this multi-institutional cohort study with target trial emulation, SGLT2 inhibitors were associated with a decreased risk of composite anemia outcomes, especially anemia event occurrences. SGLT2 inhibitors may be considered as an adjunct therapy to reduce anemia incidence in patients with T2D and CKD.

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Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO)

Cited by 273 publications

References 83 publications

Living with Chronic Kidney Disease and Type 2 Diabetes Mellitus: The Patient and Clinician Perspective

Living with Chronic Kidney Disease and Type 2 Diabetes Mellitus: The Patient and Clinician Perspective

Electronic Health Record Population Health Management for Chronic Kidney Disease Care

Use of SGLT2 Inhibitors vs GLP-1 RAs and Anemia in Patients With Diabetes and CKD

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