Recommendations for managing chronic kidney disease (CKD) in people with diabetes, focusing on glucose management, blood pressure control, and various treatments and monitoring strategies to slow CKD progression.

Optimize Glucose Management:

• Continue to focus on managing glucose to reduce the risk or slow progression of CKD.

Optimize Blood Pressure Control:

• Control blood pressure and minimize variability to reduce both CKD progression and cardiovascular risk.

Monitoring and Medication Adjustments:

• ACE Inhibitors, ARBs, and Mineralocorticoid Receptor Antagonists: – Periodic monitoring for changes in serum creatinine, potassium, and potential hypokalemia when using these medications.

• Not recommended for primary prevention of CKD in people with normal blood pressure, UACR (<30 mg/g creatinine), and normal eGFR

• Do not discontinue treatment for mild to moderate increases in serum creatinine (30%) without signs of fluid depletion

SGLT2 Inhibitors for CKD Progression:

• Recommended for individuals with type 2 diabetes and CKD to reduce CKD progression and cardiovascular events if eGFR is ≥20 mL/min/1.73 m² and urinary albumin is ≥200 mg/g creatinine
• Use SGLT2 inhibitors even if urinary albumin is normal or ranges up to 200 mg/g creatinine

Additional Cardiovascular Risk Reduction:

• Consider other treatments like SGLT2 inhibitors, GLP-1 receptor agonists, or nonsteroidal mineralocorticoid receptor antagonists to reduce cardiovascular risk in individuals with CKD and diabetes.

Albuminuria Management:

• For individuals with 300 mg/g urinary albumin or higher, a reduction of 30% or more in albuminuria is recommended to slow CKD progression.

Dietary Protein Recommendations:

• Non-dialysis dependent stage G3 or higher CKD: Target dietary protein intake of 0.8 g/kg body weight per day.
• Dialysis patients: Target intake of 1.0–1.2 g/kg body weight per day to address protein energy wasting.

Referral to Nephrologist:

• Prompt referral for uncertainties about the etiology of kidney disease, difficult management issues, or rapidly progressing CKD.

• Referral is recommended if there is continuously increasing urinary albumin, decreasing eGFR, or if eGFR is <30 mL/min/1.73 m².

Source- http://diabetesjournals.org/care/article-pdf/47/Supplement_1/S219/740379/dc24s011.pdf