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Layered Approach Recommended for Patients With Diabetes, CKD

Layered approach involves initially combining lifestyle interventions, self-management, and first-line pharmacotherapy

By Elana Gotkine HealthDay Reporter

MONDAY, Jan. 9, 2023 (HealthDay News) — A layered approach to care is recommended for patients with diabetes and chronic kidney disease (CKD), according to an updated clinical practice guideline published online Jan. 10 in the Annals of Internal Medicine.

Sankar D. Navaneethan, M.D., M.P.H., from the Baylor College of Medicine in Houston, and colleagues updated the 2020 guideline from Kidney Disease: Improving Global Outcomes (KDIGO). Recommendations in the chapters “Comprehensive Care in Patients With Diabetes and CKD” (Chapter 1) and “Glucose-Lowering Therapies in Patients With T2D [type 2 diabetes] and CKD” (Chapter 4) were updated based on new evidence.

The authors note that the updated guideline includes 13 recommendations and 52 practice points relating to care for patients with diabetes and CKD. Using a layered approach to care, the guidelines focus on preserving kidney function and maintaining well-being, starting with lifestyle interventions, self-management, and first-line pharmacotherapy (e.g., sodium-glucose cotransporter-2 inhibitors) demonstrated to improve clinical outcomes. Additional drugs providing heart and kidney protection, such as glucagon-like peptide-1 receptor agonists and nonsteroidal mineralocorticoid receptor antagonists, are added to this, as are interventions to control risk factors for CKD progression and cardiovascular events.

“The KDIGO layered approach includes the preference for starting new treatments one at a time and then reassessing response and residual risk to further refine therapy,” the authors write.

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