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

In the paper

“Moreover, CKD markedly amplifies risks of ASCVD, heart failure (HF), cardiovascular death, and all-cause mortality among people with diabetes (7,8).”

What the sources say

• ?Not checked — no full text of the sourcecites [7] Afkarian, 2013, Kidney disease and increased mortality risk in type 2 diabetes, J Am Soc Nephrol source
• Partly supported

  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)

  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 sourceExperimental — accuracy not yet measured

In the paper

“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).”

What the sources say

• Partly supported

  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)

  cites [23] Chen, 2019, Chronic kidney disease diagnosis and management: a review, JAMA sourceExperimental — accuracy not yet measured
• Partly supported

  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)

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

  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)

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

In the paper

“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).”

What the sources say

• Partly supported

  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)

  cites [1] American Diabetes Association, 2022, Standards of Medical Care in Diabetes—2022, Diabetes Care sourceExperimental — accuracy not yet measured
• Supported

  For the KDIGO portion of this jointly cited sentence, the Abstract (p. 17) says the guideline followed an explicit evidence-review and appraisal process, using systematic reviews and GRADE. The Introduction (p. 18) describes the structured literature search and reassessment of recommendations for diabetes and CKD. (LLM, conf=0.91)

  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

In the paper

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

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be 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
• Partly supported

  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)

  cites [4] Afkarian, 2016, Clinical manifestations of kidney disease among US adults with diabetes, 1988-2014, JAMA sourceExperimental — accuracy not yet measured

In the paper

“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.”

What the sources say

• ?Could not verify

  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)

  cites [1] American Diabetes Association, 2022, Standards of Medical Care in Diabetes—2022, Diabetes Care sourceExperimental — accuracy not yet measured
• Partly supported

  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)

  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 sourceExperimental — accuracy not yet measured

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites [7] Afkarian, 2013, Kidney disease and increased mortality risk in type 2 diabetes, J Am Soc Nephrol source
• Partly supported

  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)

  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 sourceExperimental — accuracy not yet measured

In the paper

“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).”

What the sources say

• Supported

  Section 1.1 (p. 30) says education should engage people with diabetes and CKD to self-manage their disease and participate in shared decisions about their care. This supports the claim as attributed to the KDIGO guideline; the separate ADA citation is not assessed here. (LLM, conf=0.94)

  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
• ?Not checked — no full text of the sourcecites [31] Draznin, 2022, 5. Facilitating behavior change and well-being to improve health outcomes: Standards of Medical Care in Diabetes—2022, Diabetes Care source

In the paper

“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).”

What the sources say

• Partly supported

  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)

  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 sourceExperimental — accuracy not yet measured

In the paper

“Both the ADA and KDIGO recommend annual screening of patients with diabetes for CKD (17,18) (Fig. 1).”

What the sources say

• ?Not checked — no full text of the sourcecites [17] Draznin, 2022, 11. Chronic kidney disease and risk management: Standards of Medical Care in Diabetes—2022, Diabetes Care source
• Partly supported

  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)

  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 sourceExperimental — accuracy not yet measured

In the paper

“Therefore, both the ADA (1) and KDIGO (2) emphasize the importance of comprehensive, holistic, patient-centered medical care to improve overall patient outcomes.”

What the sources say

• Supported

  The ADA citation supports the ADA portion of the sentence; KDIGO is cited separately. The Introduction (p. 1) calls for multifactorial care beyond glycemic control and says recommendations should be adjusted for individual preferences and comorbidities. It also states that the recommended actions are intended to improve health outcomes for patients with diabetes. (LLM, conf=0.92)

  cites [1] American Diabetes Association, 2022, Standards of Medical Care in Diabetes—2022, Diabetes Care source
• Supported

  For the KDIGO portion of the sentence, Section 5.2 (p. 29) recommends team-based, integrated care to provide comprehensive care for people with diabetes and CKD. Section 1.1 (p. 30) places the patient at the center of a multidisciplinary team and emphasizes shared decision-making. The separate ADA citation is not assessed here. (LLM, conf=0.92)

  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

In the paper

“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).”

What the sources say

• Partly supported

  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)

  cites [1] American Diabetes Association, 2022, Standards of Medical Care in Diabetes—2022, Diabetes Care sourceExperimental — accuracy not yet measured
• Supported

  Practice Point 3.1.1 (3.1 Nutrition intake, p. 64) advises an individualized diet high in vegetables, fruits, and whole grains and lower in refined carbohydrates and sweetened beverages for patients with diabetes and CKD. The same section emphasizes a balanced diet of healthy foods. This establishes the KDIGO portion of the jointly cited claim; the ADA portion is attributed to the other citation. (LLM, conf=0.93)

  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

In the paper

“ACR has marked variability; therefore, a confirmatory urine sample within 3–6 months is recommended (26,27).”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be 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
• Supported

  The section ‘Elevated ACR should be confirmed’ says urinary albumin excretion has high day-to-day variability and recommends confirming an elevated ACR with additional tests during the subsequent 3 to 6 months. The Implementation Issues section also describes a second urine test within that period. The guideline specifies two additional tests, rather than just one. (LLM, conf=0.93)

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

In the paper

“This recommendation is based on strong evidence that SGLT2i reduce CKD progression, HF, and ASCVD risk in patients with T2D and CKD.”

What the sources say

• Supported

  The guideline’s Key information (p. 45) describes moderate- to high-quality evidence that SGLT2 inhibitors reduce CKD progression and heart-failure hospitalization in patients with T2D and CKD. Key information (p. 42) also reports reduced major adverse cardiovascular events—a measure of ASCVD risk—in a CKD subgroup. (LLM, conf=0.91)

  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
• ?Not checked — no full text of the sourcecites [17] Draznin, 2022, 11. Chronic kidney disease and risk management: Standards of Medical Care in Diabetes—2022, Diabetes Care source

In the paper

“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).”

What the sources say

• Partly supported

  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)

  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 sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [37] Draznin, 2022, 7. Diabetes technology: Standards of Medical Care in Diabetes—2022, Diabetes Care source
• ?Not matched

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

  cites (Supplementary Table 1)

In the paper

“In a recent study in almost three million patients, investigators found that both classes performed similarly; however, the ARB was better tolerated (45).”

What the sources say

• Supported

  The Results identify 2,297,881 ACE-inhibitor users and 673,938 ARB users—about 2.97 million patients. The Discussion reports no statistically significant difference in effectiveness and a better safety profile for ARBs. Page numbers are not provided in our copy. (LLM, conf=0.94)

  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

In the paper

“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).”

What the sources say

• ?Could not verify

  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)

  cites [1] American Diabetes Association, 2022, Standards of Medical Care in Diabetes—2022, Diabetes Care sourceExperimental — accuracy not yet measured
• Partly supported

  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)

  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 sourceExperimental — accuracy not yet measured

In the paper

“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).”

What the sources say

• Supported

  Recommendation 10.5 in the Screening and Diagnosis section explicitly sets a target of <140/90 mmHg for people with diabetes and hypertension whose 10-year ASCVD risk is <15%. The recommendation is marked A, matching the claimed grade. (LLM, conf=0.95)

  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

In the paper

“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.”

What the sources say

• ?Could not verify

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

  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 sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [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

In the paper

“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).”

What the sources say

• Supported

  The subgroup-analysis table shows that most participants with available cardiovascular-history data had established cardiovascular disease. The Results report no significant difference in the MACE effect between participants with and without established cardiovascular disease, and the Added value of this study section says the effect was consistent across subgroups defined by cardiovascular history and baseline kidney function (eGFR). The paper reports similarity of effects, not a statistically significant reduction in every subgroup. (LLM, conf=0.90)

  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

In the paper

“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).”

What the sources say

• Partly supported

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

  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 sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [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
• Partly supported

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

  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 sourceExperimental — accuracy not yet measured

In the paper

“Esaxerenone lowered BP and albuminuria with limited changes in potassium, but long-term studies with clinical end points are lacking (85).”

What the sources say

• Partly supported

  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)

  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 sourceExperimental — accuracy not yet measured

In the paper

“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).”

What the sources say

• ?Could not verify

  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)

  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 sourceExperimental — accuracy not yet measured

In the paper

“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.”

What the sources say

• Partly supported

  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)

  cites [1] American Diabetes Association, 2022, Standards of Medical Care in Diabetes—2022, Diabetes Care sourceExperimental — accuracy not yet measured
• Supported

  Section 1.1, “Comprehensive diabetes and CKD management” (p. 30), calls for multifactorial care combining lifestyle modification with pharmacologic intervention and describes kidney and cardiovascular benefits. This supports the claim as attributed to KDIGO; the separate ADA citation is not assessed here. (LLM, conf=0.90)

  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

In the paper

“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.”

In the paper

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

In the paper

“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.”

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites [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

In the paper

“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.”

In the paper

“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 paper

“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).”

What the sources say

• ?Not matched

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

  cites (Supplementary Table 1)

In the paper

“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).”

In the paper

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

In the paper

“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.”

In the paper

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

In the paper

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

In the paper

“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.”

In the paper

“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.”

In the paper

“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.”

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites [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

In the paper

“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.”

In the paper

“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.”

In the paper

“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).”

What the sources say

• ?Not matched

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

In the paper

“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.”

In the paper

“Though specific evidence is low, smoking cessation is also strongly advised.”

In the paper

“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.”

In the paper

“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”

What the sources say

• ?Not checked — no full text of the sourcecites [36] Ikizler, 2020, KDOQI clinical practice guideline for nutrition in CKD: 2020 update, Am J Kidney Dis source

In the paper

“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).”

What the sources say

• ?Not matched

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

  cites (Supplementary Table 1)

In the paper

“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.”

In the paper

“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.”

In the paper

“All of these thresholds are proposed as starting places for individualization of targets (41).”

What the sources say

• ?Not checked — no full text of the sourcecites [41] de Boer, 2018, Individualizing blood pressure targets for people with diabetes and hypertension: comparing the ADA and the ACC/AHA recommendations, JAMA source

In the paper

“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.”

In the paper

“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.”

In the paper

“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.”

In the paper

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