Updated CKD Guidelines Emphasize Implementation of Evidence-Based Approaches

To provide guidance on the evaluation, management, and treatment of chronic kidney disease (CKD), the Kidney Disease: Improving Global Outcomes (KDIGO) organization updated its existing clinical practice guidelines. These updates were published in Annals of Internal Medicine and include both adults and children who are not receiving kidney replacement therapy.

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The guidelines emphasize the importance of tailored care, which can vary over the course of life from infants to older age. Different approaches are necessary, with prioritization depending on specific aspects of individual situations, such as sex-dependent variations in genetics, physiology, immunology, and anatomy, as well as gender-based factors (eg, identity, roles, and relations). All these factors influence CKD pathophysiology, progression, and the individual’s responses to therapy.

Further, many of the diagnostics, therapies, and strategies recommended by the guideline will only be feasible in higher-resource settings. The Work Group (WG) has integrated perspectives from representatives of low-, middle-, and high-resource countries, acknowledging the limitations in access to care in certain regions. Additionally, the guidelines raise awareness about global inequities while highlighting the evidence that supports best care, therefore facilitating better kidney health for all.

The KDIGO CKD Guideline Work Group had defined the scope of the guideline and determined topics for systematic review. For each of the review topics, an independent Evidence Review Team had systematically reviewed the evidence and graded the certainty of the evidence. Additionally, the latest searches of the English-language literature were done in July 2023, with final modification of the guideline being informed by a public review process that involved registered stakeholders during the summer of 2023.

The full guideline included 28 recommendations and 141 practice points. The synopsis published in Annals of Internal Medicine focuses on the recommendations that have the greatest evidence. The practice points reflect the expert opinion of the group where evidence is not that strong, whereas recommendations have more support.

The recommendations include the following: greater emphasis on cystatin C for assessment of glomerular filtration rate; point-of-care testing in remote areas; a shift to an individualized risk-based approach to predict kidney failure; sodium-glucose cotransporter-2 (SGLT2) inhibitors for some patients with CKD, including those with and without diabetes; and statin use for adults who are older than 50 years and have CKD.

As highlighted by the synopsis, SGLT2 inhibitors are recommended for patients with CKD, with or without diabetes, for kidney and cardiovascular benefits, as supported by previous research. Statins can also play a role in the prevention of cardiovascular disease in those with CKD. Although new diagnostics and therapies may have higher upfront costs, strategies such as the evidence-driven use of cystatin C and the benefits of SGLT2 inhibitors can help offset these costs through the reduction of misdiagnosis, improving medication dosing accuracy, and delaying disease progression.

The authors of these synopses also acknowledge limitations, including gaps in evidence for optimal treatment strategies and the underrepresentation of certain populations in clinical trials. They urge improved clinical trial participation, the use of novel study designs, and better consideration of factors (eg, the cause of CKD, sex, gender, age, and socioeconomic status) within future research. These updated recommendations and practice points can help provide guidance for how to evaluate and manage treatments for individuals living with CKD.

REFERENCE

Madero M, Levin A, Ahmed SB, et al. Evaluation and Management of Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2024 Clinical Practice Guideline. Ann Intern Med. Published March 11, 2025. doi:10.7326/ANNALS-24-01926