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Cited by 919Chronic Kidney Disease and DiabetesDiabetes Treatment and ManagementDiabetes Management and Research

Diabetes management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO)

Open access
de Boer, Ian H., Khunti, Kamlesh, Sadusky, Tami, Tuttle, Katherine R., Neumiller, Joshua J., Rhee, Connie M., Rosas, Sylvia E., Rossing, Peter +1 more·2022·Diabetes Care
DOI 10.2337/dci22-0027PMC PMC9870667

Published version of a preprint

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Abstract

People with diabetes and chronic kidney disease (CKD) are at high risk for kidney failure, atherosclerotic cardiovascular disease, heart failure, and premature mortality. Recent clinical trials support new approaches to treat diabetes and CKD. The 2022 American Diabetes Association (ADA) Standards of Medical Care in Diabetes and the Kidney Disease: Improving Global Outcomes (KDIGO) 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease each provide evidence-based recommendations for management. A joint group of ADA and KDIGO representatives reviewed and developed a series of consensus statements to guide clinical care from the ADA and KDIGO guidelines. The published guidelines are aligned in the areas of CKD screening and diagnosis, glycemia monitoring, lifestyle therapies, treatment goals, and pharmacologic management. Recommendations include comprehensive care in which pharmacotherapy that is proven to improve kidney and cardiovascular outcomes is layered on a foundation of healthy lifestyle. Consensus statements provide specific guidance on use of renin-angiotensin system inhibitors, metformin, sodium–glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, and a nonsteroidal mineralocorticoid receptor antagonist. These areas of consensus provide clear direction for implementation of care to improve clinical outcomes of people with diabetes and CKD.

Integrity signals

Registry

Crossref · 10.2337/dci22-0027

Cites

87 of 87 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

76 of 114 cited sources checked · 28 supported · 1 flagged · accuracy not yet measured

  • Findingcitation

    The GLP-1 receptor agonists with favorable CKD outcomes include lixisenatide, exenatide (once weekly), liraglutide, semaglutide, albiglutide, dulaglutide, and efpeglenatide.

    “The GLP-1 receptor agonists with favorable CKD outcomes include lixisenatide, exenatide (once weekly), liraglutide, semaglutide, albiglutide, dulaglutide, and efpeglenatide (67,68,70,72–76).”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [67] Gerstein, 2019, Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial, Lancet source
    • cites [68] Hernandez, 2018, Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial, Lancet source

      For this citation, the relevant drug is albiglutide. The Discussion reports no major difference in renal function between albiglutide and placebo over time, and the reported renal-impairment estimate includes no effect (relative risk 0.87, 95% CI 0.75–1.02). The paper establishes a cardiovascular benefit, not the favorable CKD outcome attributed to it. (LLM, conf=0.87)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [70] Marso, 2016, Semaglutide and cardiovascular outcomes in patients with type 2 diabetes, N Engl J Med source
  • Premisecitation

    Multimorbidity is common in patients with diabetes and CKD.

    “Multimorbidity is common in patients with diabetes and CKD, who are at high risk of CKD progression, cardiovascular events, and premature mortality.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [1] American Diabetes Association, 2022, Standards of Medical Care in Diabetes—2022, Diabetes Care source

      The Introduction (p. 1) says diabetes care should account for comorbidities, and Grading of Scientific Evidence (p. 2) mentions comorbid and coexisting diseases. Neither addresses whether multimorbidity is common specifically among patients with both diabetes and CKD. Searches for that claim and for CKD with coexisting conditions found no supporting passage in our copy. (LLM, conf=0.74)

      Experimental — accuracy not yet measured
    • cites [2] Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group, 2022, KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease, Kidney Int source
  • Premisecitation

    In patients with kidney failure treated with dialysis, primary prevention of ASCVD events with a statin has been generally ineffective.

    “An exception may be patients with kidney failure treated with dialysis for whom primary prevention of ASCVD events with a statin has been generally ineffective (47,49,50).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [47] Sharp Collaborative Group, 2010, Study of Heart and Renal Protection (SHARP): randomized trial to assess the effects of lowering low-density lipoprotein cholesterol among 9,438 patients with chronic kidney disease, Am Heart J source
    • cites [49] Fellström, 2009, Rosuvastatin and cardiovascular events in patients undergoing hemodialysis, N Engl J Med source

      The Primary Outcomes section reports no significant reduction in cardiovascular events with rosuvastatin, and Secondary Outcomes and Subgroups says the lack of effect was consistent among patients without preexisting cardiovascular disease. This supports the primary-prevention point for the trial’s hemodialysis patients, but the paper does not establish that statins are generally ineffective for all patients receiving dialysis. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [50] Wanner, 2004, Randomized controlled trial on the efficacy and safety of atorvastatin in patients with type 2 diabetes on hemodialysis (4D study): demographic and baseline characteristics, Kidney Blood Press Res source
  • Findingcitation

    The EMPEROR trials provided clear evidence of efficacy and safety for empagliflozin among patients with eGFR ≥20 mL/min/1.73 m2 and heart failure.

    “and the Empagliflozin Outcome Trial in Patients With Chronic Heart Failure (EMPEROR) trials (which provided clear evidence of efficacy and safety for empagliflozin among patients with eGFR ≥20 mL/min/1.73 m2 and HF) (54,57,58).”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [57] Anker, 2021, Empagliflozin in heart failure with a preserved ejection fraction, N Engl J Med source

      The Discussion reports that EMPEROR-Preserved reduced the risk of cardiovascular death or heart-failure hospitalization and notes a similar pattern of benefit in EMPEROR-Reduced. The Safety section reports adverse events, including more infections and hypotension with empagliflozin. Our copy does not establish the claimed eGFR ≥20 mL/min/1.73 m² threshold or efficacy and safety specifically down to that threshold; this paper directly studies preserved-ejection-fraction heart failure, not both trials. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [58] Packer, 2020, Cardiovascular and renal outcomes with empagliflozin in heart failure, N Engl J Med source

      The Primary Outcome and Discussion sections report that empagliflozin reduced cardiovascular death or heart-failure hospitalization in EMPEROR-Reduced, and the Discussion addresses adverse events, including more frequent uncomplicated genital infections. This paper reports one trial in patients with reduced ejection fraction; the passages in our copy do not establish the eGFR ≥20 mL/min/1.73 m² threshold or substantiate the claim about the EMPEROR trials collectively. Page numbers are unavailable in our copy. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
  • Premisecitation

    The overall risk for metformin-associated lactic acidosis is low.

    “Evidence, however, suggests the overall risk for metformin-associated lactic acidosis is low (53), and the U.S. Food and Drug Administration has revised the U.S. label to reflect its safety in most patients with eGFR ≥30 mL/min/1.73 m2 (52).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [53] Inzucchi, 2014, Metformin in patients with type 2 diabetes and kidney disease: a systematic review, JAMA source
  • May combine two claims. 34
  • Classified as probably not a substantial claim. 33

  • May combine two claims.

    Premisecitation

    CKD markedly amplifies risks of ASCVD, heart failure, cardiovascular death, and all-cause mortality among people with diabetes.

    “Moreover, CKD markedly amplifies risks of ASCVD, heart failure (HF), cardiovascular death, and all-cause mortality among people with diabetes (7,8).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [7] Afkarian, 2013, Kidney disease and increased mortality risk in type 2 diabetes, J Am Soc Nephrol source
    • cites [8] Fox, 2012, Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis, Lancet source

      The Introduction and Discussion state that people with diabetes and CKD have increased risks of cardiovascular and all-cause mortality. The Methods list heart failure and myocardial infarction among causes of cardiovascular death, but the paper does not report separate risks of heart failure or ASCVD. No page numbers are available in our copy. (LLM, conf=0.89)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Another CKD-EPI equation that additionally incorporates serum cystatin C increases precision and reduces racial and ethnic bias.

    “Another CKD-EPI equation that additionally incorporates serum cystatin C increases precision and reduces racial and ethnic bias, offering additional value in screening and for confirmation of low eGFR in appropriate cases (23–25).”
    Quote in the paperNot a substantial claim3 of 3 sources checked
    • cites [23] Chen, 2019, Chronic kidney disease diagnosis and management: a review, JAMA source

      In “CKD Definition and Staging” (page unavailable), the paper identifies the CKD-EPI creatinine–cystatin C equation and says cystatin C can be added when greater accuracy and precision are needed. It does not say that the equation reduces racial or ethnic bias. Its “Screening for CKD” section discusses creatinine and urine ACR, but does not establish the claimed screening or low-eGFR confirmation benefit for this equation. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [24] Hsu, 2021, Race, genetic ancestry, and estimating kidney function in CKD, N Engl J Med source

      The Results (Use of Cystatin C to Estimate GFR; page unavailable) and Discussion report that cystatin C–based estimates did not require race or ancestry terms and had precision similar to creatinine-based estimates. The paper studied cystatin C as an alternative to creatinine, not an additional marker in a CKD-EPI equation; it does not establish increased precision, reduced bias across ethnic groups, or the claimed screening and confirmation benefits. (LLM, conf=0.89)

      Experimental — accuracy not yet measured
    • cites [25] Levey, 2009, A new equation to estimate glomerular filtration rate, Ann Intern Med source

      The Discussion describes and evaluates a CKD-EPI equation based on serum creatinine; it calls for future evaluation of cystatin C, alone or combined with creatinine. Our copy does not assess the claimed cystatin C equation’s precision, racial or ethnic bias, or use to confirm low eGFR (pages unavailable). (LLM, conf=0.78)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    The ADA and KDIGO each follow structured processes to assess data and develop rigorous, evidence-based guidelines for adults with diabetes and CKD.

    “The American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) each follow structured processes to assess these data and develop rigorous, evidence-based guidelines for adults with diabetes and CKD (1,2).”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [1] American Diabetes Association, 2022, Standards of Medical Care in Diabetes—2022, Diabetes Care source

      The Standards of Care section (p. 1) describes the ADA’s structured literature search and annual guideline updates, while Grading of Scientific Evidence (p. 2) describes its evidence-rating system. These passages support the claim about the ADA’s process, but this paper does not establish the corresponding claim about KDIGO or specifically describe guideline development for adults with both diabetes and CKD. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [2] Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group, 2022, KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease, Kidney Int source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    CKD occurring among people with diabetes is common, morbid, and costly.

    “CKD occurring among people with diabetes is common, morbid, and costly.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [3] International Diabetes Federation . Diabetes facts & figures. Accessed 1 October 2020. Available from https://idf.org/aboutdiabetes/what-is-diabetes/facts-figures.html

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [4] Afkarian, 2016, Clinical manifestations of kidney disease among US adults with diabetes, 1988-2014, JAMA source

      The Clinical Manifestations of DKD section reports kidney disease in 26.2% of US adults with diabetes in 2009–2014, supporting “common.” The introduction describes serious complications, including end-stage renal disease, cardiovascular disease, and death, supporting “morbid.” The passages do not establish that it is costly; a search for costs and economic burden found no supporting passage. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisereasoning

    Both the ADA and KDIGO guidelines recommend a low-sodium diet (KDIGO <2,000 mg/day, ADA 1,500 to <2,300 mg/day).

    “Both guidelines also recommend a low-sodium diet (KDIGO <2,000 mg/day, ADA 1,500 to <2,300 mg/day), largely to control BP and reduce cardiovascular risk.”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [1] American Diabetes Association, 2022, Standards of Medical Care in Diabetes—2022, Diabetes Care source

      The Introduction (p. 1) describes the ADA Standards of Care generally, but gives no sodium-intake recommendation. A search of our copy for the stated sodium ranges and for sodium in relation to blood pressure or cardiovascular risk found no relevant passage. This introduction therefore cannot verify the attributed dietary guidance. (LLM, conf=0.75)

      Experimental — accuracy not yet measured
    • cites [2] Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group, 2022, KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease, Kidney Int source

      Recommendation 3.1.2 (p. 67) suggests less than 2 g (2,000 mg) of sodium per day for patients with diabetes and CKD, supporting the KDIGO portion of the claim. The passages from this guideline do not establish the stated ADA range of 1,500 to less than 2,300 mg/day, so this source does not support the claim about both guidelines. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    People with diabetes and CKD are at high risk for kidney failure, atherosclerotic cardiovascular disease, heart failure, and premature mortality.

    “People with diabetes and chronic kidney disease (CKD) are at high risk for kidney failure, atherosclerotic cardiovascular disease, heart failure, and premature mortality.”
    • Also stated in: § Background · plain
      “Moreover, CKD markedly amplifies risks of ASCVD, heart failure (HF), cardiovascular death, and all-cause mortality among people with diabetes (7,8).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [7] Afkarian, 2013, Kidney disease and increased mortality risk in type 2 diabetes, J Am Soc Nephrol source
    • cites [8] Fox, 2012, Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis, Lancet source

      The Introduction states that people with diabetes and CKD have greatly increased risks of kidney failure, cardiovascular mortality, and all-cause mortality; the Discussion also reports higher absolute risks of ESRD and death in this group. The Methods (Procedures; page not provided) define cardiovascular mortality to include deaths from myocardial infarction, heart failure, and stroke, but the paper does not establish separate risks of developing atherosclerotic cardiovascular disease or heart failure. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Both the ADA and KDIGO guidelines advocate for patients to take an active role in managing their diabetes and kidney disease.

    “The ADA and KDIGO guidelines both advocate for patients to take an active role in managing their diabetes and kidney disease and to have a voice in decisions that affect their well-being (2,31).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [2] Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group, 2022, KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease, Kidney Int source
    • cites [31] Draznin, 2022, 5. Facilitating behavior change and well-being to improve health outcomes: Standards of Medical Care in Diabetes—2022, Diabetes Care source

  • May combine two claims.

    Premisecitation

    Screening for CKD is underutilized, particularly for albuminuria; in typical U.S. practice, less than half of patients with T2D are screened for albuminuria in a given year.

    “Screening is underutilized, particularly for albuminuria. In typical practice in the U.S., less than half of patients with T2D are screened for albuminuria in a given year (19).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [19] Stempniewicz, 2021, Chronic kidney disease testing among primary care patients with type 2 diabetes across 24 U.S. health care organizations, Diabetes Care source

      The Introduction describes CKD testing in clinical practice as suboptimal, particularly for uACR. But the Abstract Results report a one-year median uACR testing rate of 52.9% across the 24 U.S. organizations—just over half, not less than half. The Conclusions likewise say only about one-half were tested within a year. (LLM, conf=0.91)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation

    Both the ADA and KDIGO recommend annual screening of patients with diabetes for CKD.

    “Both the ADA and KDIGO recommend annual screening of patients with diabetes for CKD (17,18) (Fig. 1).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [17] Draznin, 2022, 11. Chronic kidney disease and risk management: Standards of Medical Care in Diabetes—2022, Diabetes Care source
    • cites [18] Shlipak, 2021, The case for early identification and intervention of chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference, Kidney Int source

      Table 1 recommends CKD screening for people with diabetes, supporting that part of the claim. It says screening frequency should be individualized, and the discussion of repeat testing gives risk-dependent intervals rather than annual screening for all patients with diabetes. Our copy cites an ADA guideline but does not state that both the ADA and KDIGO recommend annual screening. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisereasoning

    Both the ADA and KDIGO emphasize the importance of comprehensive, holistic, patient-centered medical care to improve overall patient outcomes.

    “Therefore, both the ADA (1) and KDIGO (2) emphasize the importance of comprehensive, holistic, patient-centered medical care to improve overall patient outcomes.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [1] American Diabetes Association, 2022, Standards of Medical Care in Diabetes—2022, Diabetes Care source
    • cites [2] Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group, 2022, KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease, Kidney Int source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Both the ADA and KDIGO guidelines recommend individualized and balanced diets that are high in vegetables, fruits, and whole grains but low in refined carbohydrates and sugar-sweetened beverages.

    “The ADA and KDIGO guidelines both recommend individualized and balanced diets that are high in vegetables, fruits, and whole grains but are low in refined carbohydrates and sugar-sweetened beverages (1,2).”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [1] American Diabetes Association, 2022, Standards of Medical Care in Diabetes—2022, Diabetes Care source

      The Introduction (p. 1) says ADA recommendations should be adjusted for individual preferences, and Grading of Scientific Evidence (p. 2) emphasizes individual circumstances. This supports individualization of care, but this introduction does not give the claimed dietary recommendations or discuss KDIGO guidelines. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
    • cites [2] Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group, 2022, KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease, Kidney Int source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisereasoning

    ACR has marked variability; therefore, a confirmatory urine sample within 3-6 months is recommended.

    “ACR has marked variability; therefore, a confirmatory urine sample within 3–6 months is recommended (26,27).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [26] Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group, 2013, KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease, Kidney Int

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [27] KDOQI, 2007, KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease, Am J Kidney Dis source

  • May combine two claims.

    Findingcitation

    SGLT2 inhibitors reduce CKD progression, heart failure, and ASCVD risk in patients with T2D and CKD.

    “This recommendation is based on strong evidence that SGLT2i reduce CKD progression, HF, and ASCVD risk in patients with T2D and CKD.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [2] Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group, 2022, KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease, Kidney Int source
    • cites [17] Draznin, 2022, 11. Chronic kidney disease and risk management: Standards of Medical Care in Diabetes—2022, Diabetes Care source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The ADA and KDIGO guidelines highlight the important role of CGM technology in improving diabetes management as a tool to identify and correct glycemic derangements, prevent hypoglycemia, direct medication management, and guide medical nutritional therapy and physical activity.

    “The ADA and KDIGO guidelines highlight the important role of CGM technology in improving diabetes management as a tool to identify and correct glycemic derangements, prevent hypoglycemia, direct medication management, and guide medical nutritional therapy and physical activity, as well as its rapid evolution in affordability and accuracy (2,37) (Supplementary Table 1).”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [2] Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group, 2022, KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease, Kidney Int source

      The Rationale (p. 58) and CGM discussion (pp. 59–60) support using monitoring to improve glycemic control, avoid hypoglycemia, and inform treatment decisions in people with diabetes and CKD. They do not describe CGM as a guide to nutritional therapy or physical activity. The discussion says devices are rapidly evolving, but notes differences in cost and accuracy rather than improvements in affordability and accuracy. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [37] Draznin, 2022, 7. Diabetes technology: Standards of Medical Care in Diabetes—2022, Diabetes Care source
    • cites (Supplementary Table 1)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    In a recent study in almost three million patients, both ACEi and ARB classes performed similarly; however, the ARB was better tolerated.

    “In a recent study in almost three million patients, investigators found that both classes performed similarly; however, the ARB was better tolerated (45).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [45] Chen, 2021, Comparative first-line effectiveness and safety of ACE (angiotensin-converting enzyme) inhibitors and angiotensin receptor blockers: s multinational cohort study, Hypertension source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The ADA and KDIGO guidelines advise moderate to intense/vigorous physical activity with a cumulative duration of ≥150 min/week and avoidance of sedentary activity.

    “The ADA and KDIGO guidelines also advise moderate to intense/vigorous physical activity with a cumulative duration of ≥150 min/week and avoidance of sedentary activity (1,2).”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [1] American Diabetes Association, 2022, Standards of Medical Care in Diabetes—2022, Diabetes Care source

      The Introduction (p. 1) describes the ADA Standards of Care generally, but does not state a physical-activity recommendation. Searches of our copy for 150 minutes per week, moderate-to-vigorous activity, and avoidance of sedentary activity found no passage addressing those specifics. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
    • cites [2] Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group, 2022, KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease, Kidney Int source

      Section 3.2 (p. 25) recommends at least 150 minutes per week of moderate-intensity physical activity for patients with diabetes and CKD, or activity compatible with their cardiovascular and physical tolerance. It also advises avoiding sedentary behavior. The 150-minute recommendation does not prescribe vigorous activity; vigorous intensity appears separately as an option to consider when advising patients at higher risk of falls. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation

    For patients with diabetes, hypertension, and low cardiovascular risk (defined as those with 10-year ASCVD risk <15%), the ADA recommends a BP target of <140/90 mmHg (grade A recommendation).

    “For patients with diabetes, hypertension, and low cardiovascular risk (defined as those with 10-year ASCVD risk <15%), the ADA recommends a BP target of <140/90 mmHg (grade A recommendation) (40).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [40] American Diabetes Association Professional Practice Committee, 2022, 10. Cardiovascular disease and risk management: Standards of Medical Care in Diabetes—2022, Diabetes Care source

  • May combine two claims.

    Findingcitation

    In a glycemic efficacy and safety trial in patients with moderate-to-severe CKD (CKD stages G3 and G4), dulaglutide produced similar glycemic control but resulted in significantly slower GFR decline compared with insulin glargine as basal therapy.

    “In a glycemic efficacy and safety trial in patients with moderate-to-severe CKD (CKD stages G3 and G4), dulaglutide was compared with insulin glargine as basal therapy (71,77). Dulaglutide produced similar glycemic control but resulted in significantly slower GFR decline.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [71] Sattar, 2021, Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of randomised trials, Lancet Diabetes Endocrinol source

      Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [77] Tuttle, 2018, Dulaglutide versus insulin glargine in patients with type 2 diabetes and moderate-to-severe chronic kidney disease (AWARD-7): a multicentre, open-label, randomised trial, Lancet Diabetes Endocrinol source

  • May combine two claims.

    Findingcitation

    Although most participants in the cardiovascular outcomes trials of GLP-1 receptor agonists had established cardiovascular disease, the MACE reduction was similar between those with and without previous cardiovascular or kidney disease.

    “Although most participants in the cardiovascular outcomes trials of GLP-1 receptor agonists had established cardiovascular disease, the MACE reduction was similar between those with and without previous cardiovascular or kidney disease (71).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [71] Sattar, 2021, Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of randomised trials, Lancet Diabetes Endocrinol source

  • May combine two claims.

    Interpretationcitation

    Direct evidence supporting initiation of an SGLT2 inhibitor for patients with T2D and eGFR 20-29 mL/min/1.73 m2 is strongest for patients with concomitant albuminuria or heart failure, though efficacy and safety are generally consistent among trial participants with or without these conditions.

    “Based on these results, direct evidence supporting initiation of an SGLT2i for patients with T2D and eGFR 20–29 mL/min/1.73 m2 is strongest for patients with concomitant albuminuria or HF, though the efficacy and safety of SGLT2i are generally consistent among trial participants with or without these conditions (56,61,62).”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [56] Neuen, 2019, SGLT2 inhibitors for the prevention of kidney failure in patients with type 2 diabetes: a systematic review and meta-analysis, Lancet Diabetes Endocrinol source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [61] Razuk, 2022, SGLT-2 inhibitors and cardiovascular outcomes in patients with and without a history of heart failure: a systematic review and meta-analysis, Eur Heart J Cardiovasc Pharmacother source
    • cites [62] Staplin, 2021, Net effects of sodium-glucose co-transporter-2 inhibition in different patient groups: a meta-analysis of large placebo-controlled randomized trials, EClinicalMedicine source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Esaxerenone lowered blood pressure and albuminuria with limited changes in potassium in people with type 2 diabetes and chronic kidney disease, but long-term studies with clinical end points are lacking.

    “Esaxerenone lowered BP and albuminuria with limited changes in potassium, but long-term studies with clinical end points are lacking (85).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [85] Ito, 2020, Esaxerenone (CS-3150) in patients with type 2 diabetes and microalbuminuria (ESAX-DN): phase 3 randomized controlled clinical trial, Clin J Am Soc Nephrol source

      The Results report lower blood pressure and albuminuria with esaxerenone, and the Discussion says 52 weeks may be insufficient to determine its longer-term effects; the study measured albuminuria rather than long-term clinical kidney outcomes. But “limited changes in potassium” understates the safety finding: the Results report elevated potassium in 9% of esaxerenone patients versus 2% on placebo, with 4% versus less than 1% discontinuing because of hyperkalemia. Page numbers were not available in our copy. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    GLP-1 receptor agonists reduce albuminuria and slow eGFR decline, as evidenced by secondary outcomes in cardiovascular outcomes trials and a clinical trial for glycemic efficacy and safety in patients with T2D and eGFR 15-59 mL/min/1.73 m2.

    “GLP-1 receptor agonists reduce albuminuria and slow eGFR decline, as evidenced by secondary outcomes assessed in the cardiovascular outcomes trials and a clinical trial for glycemic efficacy and safety in patients with T2D and eGFR 15–59 mL/min/1.73 m2 (2).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [2] Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group, 2022, KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease, Kidney Int source

      The Key information passage (p. 44) attributes reduced albuminuria and slower eGFR decline to SGLT2 inhibitors, not GLP-1 receptor agonists. Our copy lists a GLP-1 trial in the references (p. 126), but the passages found do not report its kidney results or establish the claimed eGFR range. I searched for GLP-1 kidney outcomes, AWARD-7, and the 15–59 eGFR range; the relevant discussion may be missing from the truncated copy. (LLM, conf=0.70)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation

    Both the 2022 ADA Standards of Care and KDIGO 2022 guideline recommend comprehensive care in which pharmacotherapy that is proven to improve clinical kidney and cardiovascular outcomes is layered upon a foundation of healthy lifestyle approaches.

    “Both recommend comprehensive care in which pharmacotherapy that is proven to improve clinical kidney and cardiovascular outcomes is layered upon a foundation of healthy lifestyle approaches.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [1] American Diabetes Association, 2022, Standards of Medical Care in Diabetes—2022, Diabetes Care source

      The Introduction (p. 1) describes multifactorial risk reduction and says the ADA Standards include therapeutic actions intended to improve health outcomes. The Grading of Scientific Evidence section (p. 2) also discusses multiple risk-factor control. This copy does not specify pharmacotherapy layered on healthy lifestyle approaches or identify improved kidney and cardiovascular outcomes; it cannot establish what KDIGO recommends. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
    • cites [2] Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group, 2022, KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease, Kidney Int source

  • Classified as probably not a substantial claim.

    Findingnone given

    Consensus statements provide specific guidance on use of renin-angiotensin system inhibitors, metformin, sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, and a nonsteroidal mineralocorticoid receptor antagonist.

    “Consensus statements provide specific guidance on use of renin-angiotensin system inhibitors, metformin, sodium–glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, and a nonsteroidal mineralocorticoid receptor antagonist.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Findingnone given

    The published ADA and KDIGO guidelines are aligned in the areas of CKD screening and diagnosis, glycemia monitoring, lifestyle therapies, treatment goals, and pharmacologic management.

    “The published guidelines are aligned in the areas of CKD screening and diagnosis, glycemia monitoring, lifestyle therapies, treatment goals, and pharmacologic management.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    The ADA and KDIGO BP recommendations share many similarities, including a focus on proper BP measurement techniques, individualization of BP targets, and preferred drugs for treatment.

    “The ADA and KDIGO BP recommendations share many similarities, including a focus on proper BP measurement techniques, individualization of BP targets, and preferred drugs for treatment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Nausea, vomiting, and diarrhea occur in 15-20% of patients with moderate-to-severe CKD (CKD stages G3 and G4) but usually are tolerable with dose titration and abate over several weeks to months.

    “These symptoms occur in 15–20% of patients with moderate-to-severe CKD (CKD stages G3 and G4) but usually are tolerable with dose titration and abate over several weeks to months (77).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [77] Tuttle, 2018, Dulaglutide versus insulin glargine in patients with type 2 diabetes and moderate-to-severe chronic kidney disease (AWARD-7): a multicentre, open-label, randomised trial, Lancet Diabetes Endocrinol source

  • May combine two claims.

    Findingnone given

    Although short-term studies demonstrated added benefit of the combination of ACEi and ARBs in albuminuria reduction, long-term studies showed no benefit and more adverse events, particularly hyperkalemia and acute kidney injury.

    “Although short-term studies demonstrated added benefit of the combination of ACEi and ARBs in albuminuria reduction, long-term studies showed no benefit and more adverse events, particularly hyperkalemia and AKI, and thus avoidance of this combination is recommended.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    In the setting of lower levels of albuminuria (30-299 mg/g), ACEi or ARB therapy has been demonstrated to reduce progression to more advanced albuminuria (≥300 mg/g) and cardiovascular events but not progression to kidney failure.

    “In the setting of lower levels of albuminuria (30–299 mg/g), ACEi or ARB therapy has been demonstrated to reduce progression to more advanced albuminuria (≥300 mg/g) and cardiovascular events but not progression to kidney failure.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Both the ADA and KDIGO guidelines underscore the integral role of medical nutritional therapy, including access to a specialty-trained registered dietitian nutritionist, for optimal diabetes management.

    “Both the ADA and KDIGO guidelines underscore the integral role of medical nutritional therapy, including adequate access to nutritional management from a specialty-trained registered dietitian nutritionist (RD/RDN), for optimal diabetes management (Supplementary Table 1).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites (Supplementary Table 1)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Consensus statements were drafted when recommendations from each organization were aligned and supported by high-quality evidence from randomized clinical trials.

    “Consensus statements were drafted when recommendations from each organization were aligned and supported by high-quality evidence from randomized clinical trials (ada/kdigo consensus statements).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Areas of consensus between the two guidelines represent independent agreement on high priority areas of care.

    “Areas of consensus between the two guidelines therefore represent independent agreement on high priority areas of care.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisenone given

    The ADA and KDIGO guidelines recommend targeting a dietary protein intake of 0.8 g/kg/day.

    “The ADA and KDIGO guidelines also recommend targeting a dietary protein intake of 0.8 g/kg/day, the same intake recommended by the World Health Organization for the general population.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    RAS inhibitors, SGLT2i, and the ns-MRA finerenone all cause initial hemodynamic reductions in GFR.

    “For example, RAS inhibitors, SGLT2i, and the ns-MRA finerenone all cause initial hemodynamic reductions in GFR.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    A joint writing group of ADA and KDIGO representatives convened to compare and contrast ADA and KDIGO recommendations.

    “A joint writing group of ADA and KDIGO representatives convened to compare and contrast ADA and KDIGO recommendations.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisenone given

    The 2022 ADA Standards of Medical Care in Diabetes and the KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease each provide evidence-based recommendations for management.

    “The 2022 American Diabetes Association (ADA) Standards of Medical Care in Diabetes and the Kidney Disease: Improving Global Outcomes (KDIGO) 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease each provide evidence-based recommendations for management.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A series of virtual meetings were held from March 2021 through February 2022 to define scope, review published guidelines and supportive evidence, and jointly write and revise the consensus report.

    “A series of virtual meetings were held from March 2021 through February 2022 to define scope, review published guidelines and supportive evidence, and jointly write and revise the consensus report.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    All consensus statements were endorsed by both the ADA and KDIGO and represent broad agreement on evidence-based management of adults with diabetes and CKD.

    “However, all consensus statements were endorsed by both the ADA and KDIGO and represent broad agreement on evidence-based management of adults with diabetes and CKD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease recommends a target systolic BP of <120 mmHg with assessment via standardized guideline-recommended office measurement in CKD patients (grade 2B recommendation), based largely on a single, high-quality RCT that was conducted exclusively in people without diabetes.

    “The KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease recommends a target systolic BP of <120 mmHg with assessment via standardized guideline-recommended office measurement in CKD patients (grade 2B recommendation), based largely on a single, high-quality RCT that was conducted exclusively in people without diabetes (39).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group, 2021, KDIGO 2021 clinical practice guideline for the management of blood pressure in chronic kidney disease, Kidney Int source

  • May combine two claims.

    Premisenone given

    CGM may provide an advantage in glycemic control assessment among patients with T1D, as well as patients with T2D using glucose-lowering therapies associated with hypoglycemia.

    “Furthermore, ADA and KDIGO underscore that CGM may provide an advantage in glycemic control assessment among patients with T1D, as well as patients with T2D using glucose-lowering therapies associated with hypoglycemia.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    Other technologies supported by the ADA include sensor-augmented pumps that suspend insulin when glucose is low or predicted to become low, as well as automated insulin delivery systems that increase and decrease insulin delivery based on sensor-derived glucose levels and trends.

    “Other technologies supported by the ADA include sensor-augmented pumps that suspend insulin when glucose is low or predicted to become low, as well as automated insulin delivery systems that increase and decrease insulin delivery based on sensor-derived glucose levels and trends.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Metformin is excreted unchanged in urine, and its label includes a boxed warning for increased risk of lactic acidosis in patients with CKD due to impaired metformin excretion.

    “Metformin is excreted unchanged in urine, with the label including a boxed warning for increased risk of lactic acidosis in patients with CKD due to impaired metformin excretion (52).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [52] Glucophage [package insert] . Princeton, NJ, Bristol-Myers Squibb Company, 2018. Accessed 31 March 2022. Available from https://packageinserts.bms.com/pi/pi_glucophage.pdf

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Premisecitation

    The KDIGO Blood Pressure Work Group outlined certain caveats with respect to safety considerations and/or limited evidence for this threshold in certain populations, including those with diabetes and CKD.

    “However, the KDIGO Blood Pressure Work Group outlined certain caveats with respect to safety considerations and/or limited evidence for this threshold in certain populations, including those with diabetes and CKD.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Smoking cessation is strongly advised, though specific evidence is low.

    “Though specific evidence is low, smoking cessation is also strongly advised.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisenone given

    For patients with diabetes, hypertension, and high cardiovascular risk (i.e., 10-year ASCVD risk ≥15%), the ADA advises a BP target of <130/80 mmHg if this target can be safely attained.

    “For patients with diabetes, hypertension, and high cardiovascular risk (i.e., 10-year ASCVD risk ≥15%), the ADA advises a BP target of <130/80 mmHg if this target can be safely attained.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The NKF KDOQI has somewhat different recommendations, including restricting dietary protein to 0.55-0.60 g/kg/day for metabolically stable CKD patients without diabetes and to 0.6-0.8 g/kg/day for patients with diabetes and CKD.

    “While the ADA and KDIGO are aligned in this regard, the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) has somewhat different recommendations, including restricting dietary protein to 0.55–0.60 g/kg/day (or lower with keto acid analog supplementation) for metabolically stable CKD patients without diabetes and to 0.6–0.8 g/kg/day for patients with diabetes and CKD”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] Ikizler, 2020, KDOQI clinical practice guideline for nutrition in CKD: 2020 update, Am J Kidney Dis source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Both the ADA and KDIGO recommend twice-yearly glycemic assessment using HbA1c among stable patients with T2D who are meeting treatment goals and quarterly assessment among those who are intensively managed, whose therapy has changed, or whose treatment goals are not met.

    “Both the ADA and KDIGO recommend twice-yearly glycemic assessment using glycated hemoglobin (HbA1c) among stable patients with T2D who are meeting treatment goals and quarterly assessment among those who are intensively managed, whose therapy has changed, or whose treatment goals are not met (Supplementary Table 1).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites (Supplementary Table 1)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisenone given

    The ADA recommends a starting HbA1c target of <7% to reduce microvascular complications in most nonpregnant adult patients with T1D and T2D without hypoglycemia risk, although with higher goals (i.e., <8%) acceptable for patients with limited life expectancy and in whom the harms of treatment may outweigh the benefits.

    “The ADA recommends a starting HbA1c target of <7% to reduce microvascular complications in most nonpregnant adult patients with T1D and T2D without hypoglycemia risk, although with higher goals (i.e., <8%) acceptable for patients with limited life expectancy and in whom the harms of treatment may outweigh the benefits.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Based on RCT data, KDIGO recommends an individualized HbA1c target of <6.5% to <8.0% for patients with diabetes and CKD, with targets in this range having been associated with improvements in survival, cardiovascular outcomes, and microvascular end points, as well as lower risk of CKD progression.

    “Based on RCT data, KDIGO recommends an individualized HbA1c target of <6.5% to <8.0% for patients with diabetes and CKD, with targets in this range having been associated with improvements in survival, cardiovascular outcomes, and microvascular end points, as well as lower risk of CKD progression.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    All of these thresholds are proposed as starting places for individualization of targets.

    “All of these thresholds are proposed as starting places for individualization of targets (41).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [41] de Boer, 2018, Individualizing blood pressure targets for people with diabetes and hypertension: comparing the ADA and the ACC/AHA recommendations, JAMA source

  • May combine two claims.

    Premisenone given

    There are no long-term kidney outcome studies with spironolactone, and only one study in heart failure with reduced ejection fraction with a mean follow-up of 2 years that showed benefit.

    “There are no long-term kidney outcome studies with spironolactone, and only one study in heart failure with reduced ejection fraction with a mean follow-up of 2 years that showed benefit.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The benefits of SGLT2 inhibitors in kidney transplant recipients have not been confirmed in clinical trials, and there is a theoretical concern that infection risks may be increased due to immunosuppression.

    “However, these benefits have not been confirmed in clinical trials, and there is a theoretical concern that infection risks (i.e., genital mycotic infections, urinary tract infections, Fournier gangrene) may be increased due to immunosuppression.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    SGLT2 inhibitors are promising drugs for kidney transplant recipients because they reduce intraglomerular pressure, which may be elevated in single functional kidneys, and may improve graft outcomes through this and other mechanisms.

    “SGLT2i are promising drugs for kidney transplant recipients because they reduce intraglomerular pressure, which may be elevated in single functional kidneys, and may improve graft outcomes through this and other mechanisms.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    This consensus approach to management is based on high-quality evidence.

    “This consensus approach to management is based on high-quality evidence.”
    Quote in the paperSubstantial claim
54 of 54

  • The paper relies on this without support.

    Most episodes of metformin-associated lactic acidosis occur concurrent with other acute illness, often when acute kidney injury contributes to reduced metformin clearance.

    “Most episodes of metformin-associated lactic acidosis occur concurrent with other acute illness, often when acute kidney injury (AKI) contributes to reduced metformin clearance.”

  • The paper relies on this without support.

    Finerenone provides cardiovascular and kidney benefits in patients with type 2 diabetes and chronic kidney disease with any level of persistent albuminuria, including those with ACR <30 mg/g.

    “Therefore, it is reasonable to add finerenone to the treatment regimen of patients with T2D who have any level of persistent albuminuria despite current standard of care treatment with glucose-lowering and antihypertensive medications (Fig. 3).”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Intensive lowering of blood glucose with the goal of achieving near-normoglycemia has been shown in large randomized studies to delay the onset and progression of albuminuria and reduce eGFR in people with type 1 diabetes and type 2 diabetes.

    “Intensive lowering of blood glucose with the goal of achieving near-normoglycemia has been shown in large, randomized studies to delay the onset and progression of albuminuria and reduce eGFR in people with type 1 diabetes (52,53) and type 2 diabetes (1,(54)(55)(56)(57)(58)(59).”

    From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [1]

    Split into 2 atoms — 0 confirmed, 1 partially supported, 1 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Checked by a reasoning model — may be wrong.

    Experimental — accuracy not yet measured

  • CKD attributed to diabetes in adults occurs in 20-40% of people with diabetes.

    “In this section, the focus is on CKD attributed to diabetes in adults, which occurs in 20-40% of people with diabetes (1-4).”

    From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [1]

    The Background reports that CKD prevalence among people with diabetes is greater than 25%, and estimates that 40% develop CKD during their lifetime. It does not give a 20–40% prevalence range specifically for CKD attributed to diabetes in adults; the 40% figure is a lifetime estimate, not a prevalence estimate. Screening and Diagnosis says CKD is usually attributed to diabetes when other causes are not indicated. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • There is high biological variability of >20% between measurements in urinary albumin excretion.

    “Furthermore, because of high biological variability of >20% between measurements in urinary albumin excretion, two of three specimens of UACR collected within a 3-to 6-month period should be abnormal before considering an individual to have moderately or severely elevated albuminuria (1,12,13).”

    From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [1]

    The Screening and Diagnosis section says that urine albumin-to-creatinine ratio has marked variability and recommends a confirmatory sample within 3–6 months. It does not quantify variability as greater than 20% or specify that two of three specimens must be abnormal. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • KDIGO recommends a more comprehensive CKD staging that incorporates albuminuria at all stages of eGFR; this system is more closely associated with risk but is also more complex.

    “Furthermore, Kidney Disease: Improving Global Outcomes (KDIGO) recommends a more comprehensive CKD staging that incorporates albuminuria at all stages of eGFR; this system is more closely associated with risk but is also more complex (1).”

    From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [1]

    The Screening and Diagnosis section says KDIGO’s CKD classification uses both eGFR and albuminuria, and that risk rises with increasing albuminuria or decreasing eGFR. It does not say this system is more closely associated with risk than another staging system or that it is more complex. The copy provides no page number for this passage. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Lowering blood glucose itself helps prevent CKD and its progression.

    “Insulin alone was used to lower blood glucose in the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) study of type 1 diabetes, while a variety of agents were used in clinical trials of type 2 diabetes, supporting the conclusion that lowering blood glucose itself helps prevent CKD and its progression.”

    From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [1]

    The Glycemic Control section says that individualized HbA1c targets are associated with a lower risk of CKD progression. It does not establish that glucose lowering itself prevents CKD onset, or provide the cited DCCT/EDIC-versus-type-2-trials comparison used to support that conclusion. No page number is available in our copy. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

Cites

Flagged first, then by citations

1 of the 88 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. United States Renal Data System, 2020, 2020 USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States
  2. Centers for Disease Control and Prevention, 2020, National Diabetes Statistics Report, 2020
  3. American Diabetes Association, 2022, Introduction: Standards of Medical Care in Diabetes—2022, Diabetes Care, 45, S1, 10.2337/dc22-sint · DOI · Paper page

Cited by

Sorted by citations

Related

Authors
de Boer, I. H., Khunti, K., Sadusky, T., Tuttle, K. R., Neumiller, J. J., Rhee, C. M., Rosas, S. E., Rossing, P., & Bakris, G.
Affiliations
  • 1Kidney Research Institute, University of Washington, Seattle, WA
  • University of Leicester (GB)
  • University of Washington (US)
  • Washington State University Spokane (US)
  • University of California, Irvine (US)
  • Joslin Diabetes Center (US)
  • University of Copenhagen (DK)
  • University of Chicago (US)
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2022-10-03
Volume
45
Issue
12
Pages
3075-3090
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dci22-0027
PMC
PMC9870667
OpenAlex
W4300688387
Semantic Scholar
4305b9e5d619333fc34440b89a285ca76b72e11f
Cited by
919
References
88
Citations by year
2026: 248 · 2025: 299 · 2024: 215 · 2023: 145 · 2022: 12
FWCI
106.36
Type
journal article
Language
en
Open access
Licence
www.diabetesjournals.org/journals/pages/license (vor)
Locations
  • Diabetes Care (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, other-oa)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases (P30DK035816)
Topics
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
diabetes management, chronic kidney disease, glycemic control, renin-angiotensin system inhibitors, metformin, SGLT2 inhibitors, GLP-1 receptor agonists, non-steroidal mineralocorticoid receptor antagonists, lifestyle therapy, cardiovascular outcomes, renal failure, pharmacotherapy
MeSH terms
Diabetes Mellitus, Type 2, Humans, Kidney, Renal Insufficiency, Chronic

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-16.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-16.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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