Nutritional Management of Chronic Kidney Disease

The Kidney Disease: Improving Global Outcomes (KDIGO) organization developed clinical practice guidelines in 2012 to provide guidance on the evaluation, management, and treatment of chronic kidney disease (CKD) in adults and children who are not receiving renal replacement therapy. The KDIGO CKD Guideline Development Work Group defined the scope of the guideline, gathered evidence, determined topics for systematic review, and graded the quality of evidence that had been summarized by an evidence review team. Searches of the English-language literature were conducted through November 2012. Final modification of the guidelines was informed by the KDIGO Board of Directors and a public review process involving registered stakeholders. The full guideline included 110 recommendations. This synopsis focuses on 10 key recommendations pertinent to definition, classification, monitoring, and management of CKD in adults.

Too Many for Too Few: Finding Appropriate Nephrology Referrals for Patients With CKD That Optimize Outcomes

Chronic kidney disease (CKD) is common, but more than 30% of people with CKD are referred late, leading to increased morbidity and mortality. An updated classification of CKD, using estimated glomerular filtration rate (eGFR) allows the severity of CKD to be determined and when it is appropriate to refer to a consultant nephrologist. New approaches to the measurement of protein excretion are stressed with particular reference to using urine albumin:creatinine ratio or urine protein:creatinine ratio. Annual measurement of serum creatinine in at-risk patients is clearly outlined as are the indications for renal ultrasound examination. Two algorithms for the management of newly detected abnormal eGFR and for the management of CKD, Stages 3—5, are not in the NICE Guideline No 73 document but reflect the author's clinical experience of working in this area, with the aim of simplifying these two important topics. The safe use of angiotensin-converting-enzyme (ACE) inhibitors and angiotensin blocking agents in the everyday clinical work place is outlined. The management of CKD due to diabetic nephropathy and hypertension is an important part of diabetes management and this review of NICE Guideline No 73 on the early identification and management of CKD in adults in both primary and secondary care settings will further enable the better care of type 1 and type 2 diabetic subjects with renal impairment. Br J Diabetes Vasc Dis 2008; 8: 257—262

Moving Beyond Tools and Building Bridges: Lessons Learned From a CKD Decision Support in Primary Care

A human right to health approach for non-communicable diseases

The detection and management of chronic kidney disease lies within primary care; however, performance measures applicable in the Canadian context are lacking. We sought to develop a set of primary care quality indicators for chronic kidney disease in the Canadian setting and to assess the current state of the disease's detection and management in primary care. We used a modified Delphi panel approach, involving 20 panel members from across Canada (10 family physicians, 7 nephrologists, 1 patient, 1 primary care nurse and 1 pharmacist). Indicators identified from peer-reviewed and grey literature sources were subjected to 3 rounds of voting to develop a set of quality indicators for the detection and management of chronic kidney disease in the primary care setting. The final indicators were applied to primary care electronic medical records in the Electronic Medical Record Administrative data Linked Database (EMRALD) to assess the current state of primary care detection and management of chronic kidney disease in Ontario. Seventeen indicators made up the final list, with 1 under the category Prevalence, Incidence and Mortality; 4 under Screening, Diagnosis and Risk Factors; 11 under Management; and 1 under Referral to a Specialist. In a sample of 139 993 adult patients not on dialysis, 6848 (4.9%) had stage 3 or higher chronic kidney disease, with the average age of patients being 76.1 years (standard deviation [SD] 11.0); 62.9% of patients were female. Diagnosis and screening for chronic kidney disease were poorly performed. Only 27.1% of patients with stage 3 or higher disease had their diagnosis documented in their cumulative patient profile. Albumin-creatinine ratio testing was only performed for 16.3% of patients with a low estimated glomerular filtration rate (eGFR) and for 28.5% of patients with risk factors for chronic kidney disease. Family physicians performed relatively better with the management of chronic kidney disease, with 90.4% of patients with stage 3 or higher disease having an eGFR performed in the previous 18 months and 83.1% having a blood pressure recorded in the previous 9 months. We propose a set of measurable indicators to evaluate the quality of the management of chronic kidney disease in primary care. These indicators may be used to identify opportunities to improve current practice in Canada.

The Kidney Disease: Improving Global Outcomes (KDIGO) organization updated its existing clinical practice guideline in 2024 to provide guidance on the evaluation, management, and treatment of chronic kidney disease (CKD) in adults and children who are not receiving kidney replacement therapy. The KDIGO CKD Guideline Work Group defined the scope of the guideline and determined topics for systematic review. An independent Evidence Review Team systematically reviewed the evidence and graded the certainty of evidence for each of the review topics. Latest searches of the English-language literature were done in July 2023. Final modification of the guideline was informed by a public review process during summer of 2023 involving registered stakeholders. The full guideline included 28 recommendations and 141 practice points. This synopsis focuses on the recommendations that have the greatest evidence. Practice points reflect the expert opinion of the group where evidence is not that strong. Recommendations include greater emphasis on cystatin C for assessment of glomerular filtration rate, point-of-care testing in remote areas, a shift to an individualized risk-based approach to predict kidney failure, sodium-glucose cotransporter-2 inhibitors for some patients with CKD with and without diabetes, and statin use for adults older than 50 years and CKD. Together the recommendations and practice points provide guidance for how to evaluate and manage persons with CKD.

The optimal positioning and sequencing of sodium-glucose co-transporter 2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in adults with chronic kidney disease (CKD) with type 2 diabetes (T2D) and overweight/obesity is unclear. This Delphi panel aimed to establish expert consensus on the foundational versus adjunctive role of SGLT2is and GLP-1 RAs in this adult population. A total of 114 participants across 10 countries participated in a two-round Delphi panel (9.7% drop-off rate between rounds). Statement development was guided by a systematic literature review and 12 global experts. Consensus was pre-defined as ≥ 75% agreement/disagreement. The Delphi panel took place between 29 August and 20 October 2025. Totals of 13/30 (43%) and 7/17 (41%) statements achieved consensus in Rounds 1 and 2, respectively. Panellists agreed that SGLT2is should be foundational therapy in adults with CKD and T2D, independent of body mass index (BMI). Consensus was also achieved that GLP-1 RAs should be considered as an add-on for those with BMI ≥ 35 kg/m2 and cardiometabolic complications and comorbidities [e.g. residual glycated haemoglobin A1c (HbA1c) elevation, atherosclerotic cardiovascular disease]. Combination therapy was considered appropriate for adults with persistent kidney disease progression, high cardiovascular risk or suboptimal metabolic control. While treatment of adults with CKD and T2D should be holistic, SGLT2is should be prioritised as foundational therapy, independent of BMI, to reduce cardiorenal risk. Combination therapy with GLP-1 RAs was preferred for those with ongoing CKD progression and/or high cardiometabolic risk. Further clarity is required around the optimal timing of combination and sequential add-on therapy initiation.

The publication of an internationally accepted definition and classification of chronic kidney disease (CKD) 12 years ago precipitated a proliferation of research and literature surrounding the identification of CKD, risk...

Unleashing the Power of Renal Nutrition in Value-Based Models of Kidney Care Choices: Leveraging Dietitians’ Expertise and Medical Nutrition Therapy to Delay Dialysis Initiation

Chronic kidney disease represents a significant public health issue, affecting approximately 9.8% of the adult population in Portugal. Despite this figure, early diagnosis of this disease in high-risk groups remains limited. Although only two parameters are essential for its diagnosis - estimated glomerular filtration rate (eGFR) and albuminuria - in Portugal, over 50% of stage 3 - 5 patients have not undergone simultaneous assessment of eGFR and albumin-uria. The insufficient implementation of the simultaneous assessment of these two metrics results in an inadequate evaluation of high-risk populations. A task force of 17 Portuguese experts from the main medical specialties involved in chronic kidney disease management (Nephrology and Family Medicine) and in Clinical Pathology/Laboratory Medicine (representatives of major national laboratories) convened to develop guidelines aimed at standardizing procedures for the prescribing, determination, reporting, and interpretation of diagnostic parameters (albuminuria and eGFR based on serum creatinine) in Portugal. This effort is based on clinical practice, scientific knowledge, and international recommendations. This national consensus among the key stakeholders in the chronic kidney disease screening and diagnosis process culminated in the development of four practical guidelines. These guidelines will enable the consistent provision of eGFR and albuminuria measurements, regardless of the attending physician's medical specialty, the laboratory, or geographic location. Additionally, through this collective effort, experts want to raise awareness among national authorities to the need of developing new guidelines, based on scientific evidence and clinical practice, to address the underassessment of albuminuria and eGFR in this disease's management.

Following publication of the original article, the authors identified an error in the content. The corrected text is presented in the PDF. The original article has also been corrected. Chronic kidney disease represents a significant public health issue, affecting approximately 9.8% of the adult population in Portugal. Despite this figure, early diagnosis of this disease in high-risk groups remains limited. Although only two parameters are essential for its diagnosis - estimated glomerular filtration rate (eGFR) and albuminuria - in Portugal, over 50% of stage 3 - 5 patients have not undergone simultaneous assessment of eGFR and albuminuria. The insufficient implementation of the simultaneous assessment of these two metrics results in an inadequate evaluation of high-risk populations. A task force of 17 Portuguese experts from the main medical specialties involved in chronic kidney disease management (Nephrology and Family Medicine) and in Clinical Pathology/Laboratory Medicine (representatives of major national laboratories) convened to develop guidelines aimed at standardizing procedures for the prescribing, determination, reporting, and interpretation of diagnostic parameters (albuminuria and eGFR based on serum creatinine) in Portugal. This effort is based on clinical practice, scientific knowledge, and international recommendations. This national consensus among the key stakeholders in the chronic kidney disease screening and diagnosis process culminated in the development of four practical guidelines. These guidelines will enable the consistent provision of eGFR and albuminuria measurements, regardless of the attending physician's medical specialty, the laboratory, or geographic location. Additionally, through this collective effort, experts want to raise awareness among national authorities to the need of developing new guidelines, based on scientific evidence and clinical practice, to address the underassessment of albuminuria and eGFR in this disease's management.

The Kidney Disease: Improving Global Outcomes (KDIGO) 2024 Guideline for Identification and Management of Chronic Kidney Disease (CKD) is a welcome development, coming 12 years after the paradigm-changing 2012 guidelines. We are living in an unprecedented era in nephrology with novel therapies, including sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists and non-steroidal mineralocorticoid receptor antagonists, now being proven in multiple randomized controlled clinical trials to reduce both the progression of CKD and cardiovascular morbidity and mortality. The KDIGO 2024 CKD Guideline is aimed at a broad audience looking after children and adults with CKD and provide practical and actionable steps to improve care. This commentary reviews the guideline sections pertaining to the evaluation and risk assessment of individuals with CKD from a European perspective. We feel that despite the last guideline being published 12 years ago, and the fact that the assessment of CKD has been emphasized by many other national/international nephrology, cardiology and diabetology guidelines and societies, the diagnosis and treatment of CKD remains poor across Europe. As such, the KDIGO 2024 CKD Guideline should be seen as an urgent call to action to improve diagnosis and care of children and adults with CKD across Europe. We know what we need to do. We now need to get on and do it.

The purpose of these guidelines is to provide dietitians in Australia and New Zealand with a summary of evidence based clinical guidelines related to the dietetic management of adult patients with chronic kidney disease. The patient target group is any adult patient fulfilling the definition and diagnostic criteria of Chronic Kidney Disease (CKD), excluding those with nephrotic syndrome. These guidelines by definition also exclude acute renal failure and transplantation. The clinical questions were as follows: • At what level of GFR should patients be referred to the dietitian in order to maximise nutritional intervention opportunities? • Which specific measures best reflect nutritional status or change in nutritional status in Chronic Kidney Disease? • What are the goals of nutrition intervention for CKD? • What is (are) the appropriate nutritional intervention(s) to optimise nutritional status in Chronic Kidney Disease and prevent malnutrition? • What is the optimal method of implementation and follow up to ensure nutritional status is maintained or improved? These guidelines are meant to serve as a general framework for handling patients with particular health problems. It may not always be appropriate to use these guidelines to manage clients because individual circumstances may vary. The independent skill and judgement of the health care provider must always dictate treatment decisions. These guidelines for practice are provided with the express understanding that they do not establish or specify particular standards of care, whether legal, medical or other1.

We aimed to evaluate mortality and hospital admissions for chronic kidney disease in young adults according to sex and state in the northern region of Brazil, between 1996 and 2017. A population-based time series study using official data on mortality and hospital admissions due to chronic kidney disease in individuals aged 20 to 49 years old, residents of the northern region of Brazil, in the periods 1996–2017 and to 2008–2017, respectively. Chronic kidney disease was defined according to the International Classification of Diseases, 10th revision (N18).The evolution of mortality from chronic kidney disease decreased by 0.881% per year over the period (1996–2017). In the states of Acre and Amapá, there was a reduction of 5.85% and –5.68% per year, respectively, and in Tocantins, an increase of 4.16% per year. The incidence of hospitalization did not vary between 2008 and 2017. However, 2 states showed an increase in hospitalization rates: Acre (6.08% per year) and Pará (2.83% per year), and 2 states showed a reduction: Amazonas (5.09% per year) and Tocantins (6.23% per year).In general, there was decrease in mortality rate overtime. However, rate of mortality due to chronic kidney disease increased in the state of Tocantins. The evolution of hospitalization due to chronic kidney disease in a population of young adults remained stationary.