Navaneethan Sankar D, Zoungas Sophia, Caramori M Luiza, Chan Juliana C N, Heerspink Hiddo J L, Hurst Clint, Liew Adrian, Michos Erin D, Olowu Wasiu A, Sadusky Tami, Tandon Nikhil, Tuttle Katherine R, Wanner Christoph, Wilkens Katy G, Craig Jonathan C, Tunnicliffe David J, Tonelli Marcello, Cheung Michael, Earley Amy, Rossing Peter, de Boer Ian H, Khunti Kamlesh
Section of Nephrology, Department of Medicine, Selzman Institute for Kidney Health, Baylor College of Medicine, Institute of Clinical and Translational Research, Baylor College of Medicine, and Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas (S.D.N.).
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (S.Z.).
Ann Intern Med. 2023 Mar;176(3):381-387. doi: 10.7326/M22-2904. Epub 2023 Jan 10.
The KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease is an update of the 2020 guideline from Kidney Disease: Improving Global Outcomes (KDIGO).
The KDIGO Work Group updated the guideline, which included reviewing and grading new evidence that was identified and summarized. As in the previous guideline, the Work Group used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to appraise evidence and rate the strength of recommendations and expert judgment to develop consensus practice points. New evidence led to updating of recommendations in the chapters Comprehensive Care in Patients With Diabetes and CKD (Chapter 1) and Glucose-Lowering Therapies in Patients With T2D and CKD (Chapter 4). New evidence did not change recommendations in the chapters Glycemic Monitoring and Targets in Patients With Diabetes and CKD (Chapter 2), Lifestyle Interventions in Patients With Diabetes and CKD (Chapter 3), and Approaches to Management of Patients With Diabetes and CKD (Chapter 5).
The updated guideline includes 13 recommendations and 52 practice points for clinicians caring for patients with diabetes and chronic kidney disease (CKD). A focus on preserving kidney function and maintaining well-being is recommended using a layered approach to care, starting with a foundation of lifestyle interventions, self-management, and first-line pharmacotherapy (such as sodium-glucose cotransporter-2 inhibitors) demonstrated to improve clinical outcomes. To this are added additional drugs with heart and kidney protection, such as glucagon-like peptide-1 receptor agonists and nonsteroidal mineralocorticoid receptor antagonists, and interventions to control risk factors for CKD progression and cardiovascular events, such as blood pressure, glycemia, and lipids.
《KDIGO 2022慢性肾脏病糖尿病管理临床实践指南》是对改善全球肾脏病预后组织（KDIGO）2020年指南的更新。
KDIGO工作组更新了该指南，包括审查和分级已识别和总结的新证据。与之前的指南一样，工作组采用推荐分级的评估、制定与评价（GRADE）方法来评估证据，并对推荐强度进行评级，同时运用专家判断来制定共识性实践要点。新证据导致糖尿病和慢性肾脏病患者综合护理（第1章）以及2型糖尿病和慢性肾脏病患者降糖治疗（第4章）章节中的推荐内容有所更新。新证据未改变糖尿病和慢性肾脏病患者血糖监测与目标（第2章）、糖尿病和慢性肾脏病患者生活方式干预（第3章）以及糖尿病和慢性肾脏病患者管理方法（第5章）章节中的推荐内容。
更新后的指南为照顾糖尿病和慢性肾脏病（CKD）患者的临床医生提供了13条推荐和52个实践要点。建议采用分层护理方法，重点关注保护肾功能和维持健康，从生活方式干预、自我管理以及已证明可改善临床结局的一线药物治疗（如钠-葡萄糖协同转运蛋白2抑制剂）为基础入手。在此基础上增加具有心脏和肾脏保护作用的其他药物，如胰高血糖素样肽-1受体激动剂和非甾体类盐皮质激素受体拮抗剂，以及控制慢性肾脏病进展和心血管事件风险因素的干预措施，如血压、血糖和血脂。
