KDIGO Releases Updated 2024 CKD Clinical Practice Guideline

Paul Stevens, MB

Credit: KDIGO

Kidney Disease: Improving Global Outcomes (KDIGO) has announced the release of its 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (CKD), an update to the previous KDIGO 2012 CKD Guideline.¹

The new guideline includes 6 chapters of recommendation statements and practice guidelines reinforcing methods for accurate CKD diagnosis and prediction, incorporating novel treatment strategies and approaches to the management of CKD, and identifying future areas for research.¹

“It is time to address the care gap in those with CKD who remain undiagnosed, untreated, and undermanaged and we hope that insights and guidance from this guideline will help optimize CKD care delivery and improve outcomes for people with CKD around the world,” Paul Stevens, MB, of East Kent Hospitals University NHS Foundation Trust, said in a press release.²

The updated guideline outlines several developments introduced to clinical practice since the release of the 2012 guideline, including the refinement of glomerular filtration rate (GFR) evaluation, population and individual risk prediction, and novel treatments. Investigators noted the intended starting point for the KDIGO 2024 CKD guideline was an established diagnosis of CKD, though they also pointed out certain practice points related to the evaluation of CKD and the ascertainment of chronicity.¹

The new guideline’s 6 chapters build upon the 5 encompassed in the 2012 version with 2 different kinds of statements: graded recommendations, supported by systematic reviews, and ungraded practice points, which serve to direct clinical care or activities for which a systematic review was not conducted. Despite their differences, investigators noted both are intended to guide clinical practice and aid in decision-making surrounding CKD.¹

The first chapter of the 2024 CKD guideline pertains to the evaluation of CKD, recommending the use of both urine albumin measurement and assessment of GFR for testing individuals at risk for and with CKD. In adults at risk for CKD, investigators recommend using creatinine-based estimated glomerular filtration rate (eGFRcr), although if cystatin C is available, they note the GFR category should be estimated from the combination of creatinine and cystatin C (eGFRcr-cys).¹

The guideline also suggests performing a kidney biopsy as an acceptable, safe, diagnostic test to evaluate cause and guide treatment decisions. In cases where access to a laboratory is limited or providing a test at the point-of-care facilitates the clinical pathway, investigators suggest point-of-care testing for creatinine and urine albumin measurement.¹

The second chapter addresses risk assessment in people with CKD, recommending the assessment of albuminuria in adults, or albuminuria/proteinuria in children, and GFR at least annually in people with CKD. Of note, the guideline recommends assessing albuminuria and GFR more often for individuals at greater risk of CKD progression.¹

The guideline also recommends a comprehensive treatment strategy for reducing the risk of CKD progression and its associated complications. This includes lifestyle factors, physical activity, diet, and the conditional use of medications like renin-angiotensin-system inhibitors (RASi), sodium-glucose cotransporter-2 inhibitors (SGLT2i), mineralocorticoid receptor antagonists (MRA), and glucagon-like peptide-1 receptor agonists (GLP-1 RA).¹

Due to their increased susceptibility to the nephrotoxic effects of medications, the guideline recommends considering the benefits versus potential harms when prescribing medications to people with CKD. It also suggests performing thorough medication reviews periodically and at transitions of care to assess adherence, continued indication, and potential drug interactions, also educating and informing people with CKD about the expected benefits and possible risks of medications.¹

The guideline outlines circumstances for referring adults with CKD to specialist kidney care services and discusses the identification, assessment, and management of symptoms, the use of team-based integrated care, timing the initiation of dialysis, and other recommendations and practice points regarding optimal models of care.¹

“We are thrilled to publish this eagerly-anticipated update, which comes during a transformative period in nephrology, offering new hope for people living with kidney disease,” Adeera Levin, MD, professor of medicine and head of the division of nephrology at the University of British Columbia, said in a press release.² “By integrating the latest evidence and expert consensus, we aim to empower healthcare professionals, and patients with actionable recommendations to optimize patient outcomes and enhance quality of life.”

References:

1. ^{Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024;105(4S): S117–S314.}
2. ^{KDIGO. KDIGO Announces Publication of the 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. News. March 13, 2024. Accessed March 14, 2024. https://kdigo.org/kdigo-announces-publication-of-2024-ckd-guideline/}