Diabetes in CKD

KDIGO is updating the 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (CKD). The Diabetes Guideline Update will primarily impact Chapter 1 on comprehensive care and Chapter 4 on glucose-lowering therapies in patients with type 2 diabetes. The decision to update was based on new evidence published after the last evidence review cut-off date that could impact the existing guideline statements.

The goal of the guideline is to generate a useful resource for clinicians and patients by providing actionable recommendations with infographics based on a rigorous, formal systematic literature review. Another aim is to propose research recommendations for areas in which there are gaps in knowledge. The guideline targets a broad audience of clinicians treating diabetes and CKD while taking into account implications for policy and payment.

The development of this guideline followed an explicit process of evidence review and appraisal. Treatment approaches and guideline recommendations are based on systematic reviews of relevant studies, appraisal of the quality of the evidence, and the strength of recommendations following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Limitations of the evidence are discussed and areas for future research are presented.

The period for public review of the KDIGO Diabetes Guideline has now closed. KDIGO will incorporate feedback received during public review into a final version for publication.


This Clinical Practice Guideline is based upon the best information available at the time of publication. The recommendations are designed to provide information and assist decision-making. They are not intended to define a standard of care, and should not be construed as one. Neither should they be interpreted as prescribing an exclusive course of management. Variations in practice will inevitably and appropriately occur when clinicians take into account the needs of individual patients, available resources, and limitations unique to an institution or type of practice. Every health care professional making use of this Guideline is responsible for evaluating the appropriateness of applying them in the setting of any particular clinical situation. The recommendations for research contained within this document are general and do not imply a specific protocol.