Updated chronic kidney disease management guidelines recommend SGLT2 inhibitors regardless of diabetes or kidney disease type
The Kidney Disease: Improving Global Outcomes (KDIGO) organization updated its existing clinical practice guideline in 2024 on evaluation and management of chronic kidney disease (CKD) in adults and children. A summary of the guideline’s recommendations with the greatest evidence is published in Annals of Internal Medicine.
An Evidence Review Team from Johns Hopkins University conducted an evidence synthesis and meta-analysis of relevant studies published through July 2023. A working group comprised of nephrologists; primary care physicians; internal medicine physicians; persons living with CKD; and various other subject matter experts was comprised to help inform the clinical practice points and aid guideline development.
The full guideline included 28 recommendations and 141 practice points and emphasizes the importance of tailored care at every stage of CKD. The new guidelines emphasize the role of cystatin C for better accuracy of glomerular filtration rate (GMR) when evaluating CKD.
To reiterate the importance of early detection, especially for underserved populations, the guidelines recommend point-of-care-testing (POCT) for creatinine and urine albumin measurement in areas where lab access is limited.
There was also strong evidence for the use of an individualized, risk-based approach using validated prediction equations, like the Kidney Failure Risk Equation, for the prediction of kidney failure. Sodium–glucose cotransporter-2 inhibitors (SGLT2i) are now recommended for persons with CKD with and without diabetes for both kidney and cardiovascular benefit. The guidelines also recommend statins for adults with CKD aged 50 and older and note that they also have a role to prevent cardiovascular disease in patients with CKD.
Reference:
Magdalena Madero, Adeera Levin, Sofia B. Ahmed, et al. Evaluation and Management of Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2024 Clinical Practice Guideline. Ann Intern Med. [Epub 11 March 2025]. doi:10.7326/ANNALS-24-01926.
