Diabetes Canada is committed to developing comprehensive and evidence-based clinical practice guidelines (CPG) to ensure people living with diabetes receive the highest quality care that focuses on shared decision making and individualization of care. As part of this commitment, Diabetes Canada has released an updated chapter on chronic kidney disease (CKD) in people with diabetes.
The updated CKD guidelines, published in the Canadian Journal of Diabetes (CJD), were developed through a rigorous and transparent process, including the review, appraisal, and synthesis of thousands of published research studies, including an evaluation and grading of their relevance and quality. The result is a set of recommendations that help guide practice, inform general patterns of care, and support better outcomes for those living with diabetes. In addition to the chapter, new supplementary material highlighting the prevalence, risks, and care of hyperkalemia, including clinical practice pearls, have also been published. The chapter and supplemtary materials are open access and available on the CJD website.
“My expectation is that implementation of the recommendations of this chapter will dramatically change the natural history of diabetic nephropathy for the better and, going forward from here, almost no one who develops diabetes today, should end up on dialysis because of diabetic nephropathy.”
-Dr. Sheldon W. Tobe MD, MScCH, FRCPC, FACP, FAHA, and lead author of the CKD chapter
Highlights of recommendations for health-care providers :
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Individuals with diabetes and no history of kidney disease should be screened annually with both estimated glomerular filtration rates (eGFR) and random urine albumin to creatinine ratio (ACR) to identify individuals with CKD. For individuals with type 1 diabetes, CKD screening should begin 5 years after onset or, if onset is at an early age, screening should start after puberty. For type 2 diabetes, CKD screening should begin at diagnosis and annually thereafter.
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Individuals with diabetes and CKD should have their eGFR and spot uACR assessed at least annually with more frequent testing (every 3 to 6 months) when eGFR is <60 mL/min per 1.73 m2 or if uACR is >20 mg/mmol.
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The Kidney Failure Risk Equation (KFRE) is suggested for individuals with diabetes and CKD stages G3 to G5 for predicting the risk of end-stage kidney disease over 5 years.
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Adults with diabetes and CKD with either hypertension or albuminuria should be treated with renin angiotensin aldosterone system inhibitors (RAASi) to delay progression of CKD
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For adults with diabetes, mild hyperkalemia (defined by potassium levels between the upper limit of normal and 5.4 mmol/L) should be managed with dietary intervention. For moderate hyperkalemia (defined by potassium levels between 5.4 mmol/L and 5.9 mmol/L), it is recommended to initiate medical therapy to increase potassium excretion through the GI tract or in the urine. For severe hyperkalemia (defined by potassium 6.0 mmol/L or higher), it is suggested to hold RAASi and nsMRA medications and refer to an emergency room for management.
For people living with diabetes, key messages include:
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If you have diabetes, ensure that you receive screening tests at least annually for kidney disease—using both blood and urine tests.
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Ask your healthcare team about your risk for CKD, including your eGFR (an estimate of your kidney function) and urine ACR (a marker of active kidney damage).
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Discuss treatment options and work with your health-care team to develop an individualized healthy lifestyle plan to potentially delay or prevent the progression of kidney disease.
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Prioritize glucose-lowering therapies with additional kidney and/or heart disease benefits over treatments that only target blood glucose levels.
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High potassium levels in the blood can be dangerous. You may be asked to have blood tests to assess potassium levels when your kidney function is tested. Changes to your care may be made and follow-up tests may be conducted to ensure your potassium has returned to safe levels. This chapter (which replaces the 2018 chapter) offers a framework for clinicians and individuals with diabetes to make decisions collaboratively, aiming for earlier detection, effective management, and enhanced quality of life for those affected by diabetes and kidney disease.
To help implement the new recommendations, Diabetes Canada will offer a suite of educational resources, practice tools, and continuing education webinars tailored to healthcare providers across Canada.
Diabetes is the leading cause of kidney disease in Canada, and approximately one in three adults living with diabetes also live with kidney disease:
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People with diabetes are 10 to 15 times more likely to develop end-stage kidney disease and 12 times more likely to be hospitalized for it.
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Diabetes contributes to nearly half of all kidney failure cases requiring dialysis.
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Without timely intervention and consistent management, as many as 30 per cent of people with type 1 diabetes and up to 40 per cent of people with type 2 diabetes will progress to kidney failure.
For more information, contact:
info@diabetes.ca
Category Tags: Advocacy & Policy, Research, Announcements, Health-care, Clinical Practice Guidelines;
Region: National