The DOI matches its Crossref record; 87 of the 88 references it cites were found in a registry or an index; 76 of the 114 sources its claims cite were checked for support.
Diabetes management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO)
Open accessPublished version of a preprint
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.
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Claims the paper makes
34 Partly supported · 17 No basis given · 14 Supported · 9 Sources not found · 9 No full text of the sources · 6 Own interpretation · 4 Own method · 3 Supported so far · 2 Couldn’t confirm · 2 Not checked yet · 1 Mixed support · accuracy not yet measured
Some cited sources support this claim and some don’t — read each source’s verdict below.
In the paper
“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).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Use of Additional Glucose-Lowering Agents
What the sources say
- Not checked — no full text of the sourcecites [67] Gerstein, 2019, Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial, Lancet source
- Disputedcites [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 sourceExperimental — accuracy not yet measured
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.
- Supportedcites [70] Marso, 2016, Semaglutide and cardiovascular outcomes in patients with type 2 diabetes, N Engl J Med source
The Results report lower rates of new or worsening nephropathy with semaglutide than with placebo. The Discussion specifies that this difference was driven by macroalbuminuria. In this multi-citation sentence, this paper supports the semaglutide entry, not the claims about the other listed drugs. (LLM, conf=0.91)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Multimorbidity is common in patients with diabetes and CKD, who are at high risk of CKD progression, cardiovascular events, and premature mortality.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Comprehensive Care > Goals of Comprehensive Care
What the sources say
- Could not verifycites [1] American Diabetes Association, 2022, Standards of Medical Care in Diabetes—2022, Diabetes Care sourceExperimental — accuracy not yet measured
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)
- Supportedcites [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 1.1 (p. 30) explicitly states that multimorbidity is common among people with diabetes and CKD. This directly supports the attributed claim. (LLM, conf=0.95)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Could not verify
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“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).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Lipid Management
What the sources say
- Not checked — no full text of the sourcecites [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
- Partly supportedcites [49] Fellström, 2009, Rosuvastatin and cardiovascular events in patients undergoing hemodialysis, N Engl J Med sourceExperimental — accuracy not yet measured
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)
- Not checked — no full text of the sourcecites [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
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“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).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Glucose-Lowering Agents in T2D and CKD
What the sources say
- Partly supportedcites [57] Anker, 2021, Empagliflozin in heart failure with a preserved ejection fraction, N Engl J Med sourceExperimental — accuracy not yet measured
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)
- Partly supportedcites [58] Packer, 2020, Cardiovascular and renal outcomes with empagliflozin in heart failure, N Engl J Med sourceExperimental — accuracy not yet measured
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)
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“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).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Glucose-Lowering Agents in T2D and CKD
What the sources say
- Supportedcites [53] Inzucchi, 2014, Metformin in patients with type 2 diabetes and kidney disease: a systematic review, JAMA source
The Results (Major Findings) explicitly state that lactic acidosis during metformin therapy is very infrequent and occurs at a rate similar to the background rate in people with type 2 diabetes. The Discussion (Summary of Key Findings) likewise describes its incidence as low. The citing sentence attributes only this risk claim—not the FDA-label statement—to this source. (LLM, conf=0.94)
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“including the DAPA-CKD trial (which provided clear evidence of efficacy and safety for dapagliflozin in patients with eGFR ≥25 mL/min/1.73 m2 and ACR ≥200 mg/g)”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Glucose-Lowering Agents in T2D and CKD
What the sources say
- Partly supportedcites [54] Heerspink, 2020, Dapagliflozin in patients with chronic kidney disease, N Engl J Med sourceExperimental — accuracy not yet measured
The Abstract (p. 1437) reports that DAPA-CKD enrolled patients with eGFR of 25–75 mL/min/1.73 m² and urinary albumin-to-creatinine ratio of 200–5000 mg/g, and found a lower primary-outcome risk with dapagliflozin. The Discussion reports an acceptable safety profile. The citing sentence omits both upper eligibility limits, so its efficacy-and-safety claim reaches patients outside the studied ranges. (LLM, conf=0.85)
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Additional support comes from subgroup analyses of participants in the CREDENCE and DAPA-CKD trials with baseline eGFR <30 mL/min/1.73 m2 (59,60).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Glucose-Lowering Agents in T2D and CKD
What the sources say
- Supportedcites [59] Bakris, 2020, Effects of canagliflozin in patients with baseline eGFR <30 ml/min per 1.73 m2: subgroup analysis of the randomized CREDENCE trial, Clin J Am Soc Nephrol source
The Study Design describes a post hoc CREDENCE analysis of participants whose eGFR was below 30 mL/min/1.73 m² at randomization. The Discussion says its results support SGLT2 inhibitor treatment in these patients, specifically continuation; it does not recommend initiating treatment below that threshold. This source supports the CREDENCE part of the jointly cited sentence, not a DAPA-CKD subgroup analysis. (LLM, conf=0.90)
- Supportedcites [60] Chertow, 2021, Effects of dapagliflozin in stage 4 chronic kidney disease, J Am Soc Nephrol source
The Participants passage describes this paper's DAPA-CKD subgroup analysis of people with baseline eGFR below 30 mL/min/1.73 m² and says its benefits were consistent with the overall trial. The Discussion reports a favorable eGFR-slope result from the CREDENCE stage 4 CKD subgroup. Together, these passages support the citing sentence's broad statement about additional support from both subgroup analyses. (LLM, conf=0.88)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“To date, two clinical trials with primary kidney disease outcomes using canagliflozin and dapagliflozin (Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation [CREDENCE] and Dapagliflozin And Prevention of Adverse outcomes in Chronic Kidney Disease [DAPA-CKD]) demonstrated significant benefit for composite outcomes including end points of substantial eGFR decl”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Glucose-Lowering Agents in T2D and CKD
What the sources say
- Partly supportedcites [54] Heerspink, 2020, Dapagliflozin in patients with chronic kidney disease, N Engl J Med sourceExperimental — accuracy not yet measured
The Efficacy Outcomes section reports a significant DAPA-CKD benefit for a composite of substantial eGFR decline, end-stage kidney disease, and renal or cardiovascular death (hazard ratio 0.61; P<0.001). The Discussion says CREDENCE showed kidney-protective effects, but this copy does not specify CREDENCE’s composite endpoints or their statistical significance. (LLM, conf=0.84)
- Partly supportedcites [55] Perkovic, 2019, Canagliflozin and renal outcomes in type 2 diabetes and nephropathy, N Engl J Med sourceExperimental — accuracy not yet measured
The Outcomes and Effect on the Primary Outcome and Renal Components sections report that CREDENCE significantly reduced a composite including end-stage kidney disease, doubling of serum creatinine, and renal or cardiovascular death. The paper does not report DAPA-CKD results, so it cannot support the claim about both trials. Page numbers were not available in our copy. (LLM, conf=0.90)
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Evidence from combined major SGLT2i trials, however, suggests that kidney and cardiovascular benefits are consistent irrespective of baseline albuminuria (56), including in patients with normal albumin excretion, as reflected in the KDIGO recommendation and consensus statement supporting SGLT2i use in most patients with T2D and CKD (2).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Glucose-Lowering Agents in T2D and CKD
What the sources say
- Partly supportedcites [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
The Overall results report no evidence that the effect on the composite kidney outcome differed across baseline albuminuria groups. The Data analysis section includes a normal-albuminuria group (UACR <30 mg/g). The cited analysis does not establish that cardiovascular benefits were consistent across those groups. (LLM, conf=0.88)
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“This recommendation is based on RCTs where findings demonstrated decreased risk of CKD progression, for which patients with albuminuria are at elevated risk, with a maximally dosed RAS inhibitor compared with placebo or an active antihypertensive drug comparator (42–44).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > BP Management
What the sources say
- Partly supportedcites [42] Brenner, 2001, Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy, N Engl J Med sourceExperimental — accuracy not yet measured
The Patients section (p. 2) describes participants with type 2 diabetes and nephropathy who met a urinary albumin or protein threshold, and the Discussion (p. 4) reports reduced renal progression with losartan versus placebo. But the Results (p. 2) say doses ranged from 50 to 100 mg and only 71% received 100 mg, so this trial does not establish that all patients received a maximally dosed RAS inhibitor. (LLM, conf=0.88)
- Not checked — no full text of the sourcecites [43] Keane, 2003, The risk of developing end-stage renal disease in patients with type 2 diabetes and nephropathy: the RENAAL study, Kidney Int source
- Not checked — no full text of the sourcecites [44] Lewis, 1993, The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy, N Engl J Med source
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“KDIGO performed a systematic review of randomized trials and found no conclusive evidence that restriction of dietary protein to levels <0.8 g/kg/day improves kidney or other health outcomes among people with diabetes and CKD (2).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Comprehensive Care > Lifestyle
What the sources say
- Supportedcites [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 section (p. 65) reports a systematic review of 11 protein-restriction studies with inconclusive results, little or no effect on HbA1c, and no assessment of some cardiovascular or kidney-failure outcomes. It also says an exhaustive search found only weak to very weak evidence that limiting protein below normal recommendations slowed kidney-failure progression or reduced mortality in people with diabetes and CKD. The discussion identifies 0.8 g/kg/day as the standard intake (p. 64). (LLM, conf=0.91)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“In a meta-analysis of eight cardiovascular outcomes trials, GLP-1 receptor agonists significantly reduced risk for a composite kidney disease outcome (macroalbuminuria, eGFR decline, progression to kidney failure, or death from kidney disease) compared with placebo, largely driven by reduction in albuminuria (71).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Use of Additional Glucose-Lowering Agents
What the sources say
- Partly supportedcites [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
The Results report that the broader composite kidney outcome fell by 21% (HR 0.79, 95% CI 0.73–0.87), and the Fig. 4 caption confirms the listed components. The meta-analysis included eight cardiovascular trials, but kidney-outcome data came from five studies. The copy does not establish that the reduction was largely driven by albuminuria; it says only that macroalbuminuria was included in the composite. (LLM, conf=0.83)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Notably, the MACE risk reduction with liraglutide was significantly greater for those with eGFR <60 mL/min/1.73 m2 than for those with eGFR ≥60 mL/min/1.73 m2 (69).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Use of Additional Glucose-Lowering Agents
What the sources say
- Supportedcites [69] Mann, 2018, Effects of liraglutide versus placebo on cardiovascular events in patients with type 2 diabetes mellitus and chronic kidney disease, Circulation source
The Results section, “Primary Composite CV Outcome: Time to First Major Adverse CV Events” (page not provided), reports a greater reduction in the primary MACE composite with liraglutide for eGFR <60 than for eGFR ≥60 mL/min/1.73 m2, with an interaction P value of 0.01. The paper also notes that finer eGFR subgroup analyses did not show a consistent difference, but that does not negate the reported comparison at the claimed threshold. (LLM, conf=0.94)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“In cardiovascular outcomes trials, GLP-1 receptor agonists reduced risk of major adverse cardiovascular events (MACE) in patients with T2D (67–70).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Use of Additional Glucose-Lowering Agents
What the sources say
- Not checked — no full text of the sourcecites [67] Gerstein, 2019, Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial, Lancet source
- Supportedcites [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
The Introduction states that GLP-1 receptor agonists have been shown to reduce major adverse cardiovascular events in people with type 2 diabetes. The trial’s concluding discussion reports that albiglutide reduced that risk in patients with type 2 diabetes and established cardiovascular disease. The paper also notes that results differed among individual agonists; the citing sentence does not claim that every agonist was effective. (LLM, conf=0.91)
- Supportedcites [69] Mann, 2018, Effects of liraglutide versus placebo on cardiovascular events in patients with type 2 diabetes mellitus and chronic kidney disease, Circulation source
The Clinical Implications section reports cardiovascular benefits for GLP-1 receptor agonists in cardiovascular outcome trials involving patients with type 2 diabetes. The Results section reports that liraglutide reduced the risk of the primary composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke versus placebo. No page numbers are available in our copy. (LLM, conf=0.90)
- Supportedcites [70] Marso, 2016, Semaglutide and cardiovascular outcomes in patients with type 2 diabetes, N Engl J Med source
The Conclusions report that, in a cardiovascular outcomes trial of patients with type 2 diabetes at high cardiovascular risk, semaglutide produced a significantly lower rate of the composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke than placebo. The paper identifies semaglutide as a GLP-1 analogue, so it supports the cited sentence as an example of the trials described. (LLM, conf=0.92)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“A meta-analysis of clinical trials reported that genital mycotic infections occurred in 6% of participants assigned to an SGLT2i, compared with 1% of those assigned to placebo (65).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Glucose-Lowering Agents in T2D and CKD
What the sources say
- Partly supportedcites [65] Shi, 2019, Appraisal of non-cardiovascular safety for sodium-glucose co-transporter 2 inhibitors: a systematic review and meta-analysis of placebo-controlled randomized clinical trials, Front Pharmacol sourceExperimental — accuracy not yet measured
The Results > Safety Outcomes section reports that genital mycotic infections were more frequent with SGLT2 inhibitors than with placebo (RR 3.71). It does not give the claimed 6% and 1% incidence figures; its 21.1% and 16.5% figures refer to infections overall, not genital mycotic infections. Page numbers are unavailable in our copy. (LLM, conf=0.88)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“20% for dialysis initiation”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Renin-Angiotensin-Aldosterone System Inhibition
What the sources say
- Partly supportedcites [88] Agarwal, 2022, Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis, Eur Heart J sourceExperimental — accuracy not yet measured
The Results report a statistically significant 20% reduction with finerenone versus placebo for the ESKD component (HR 0.80; P = 0.040). But the Figure 2 caption defines that endpoint as initiation of chronic dialysis for at least 90 days or kidney transplantation, so the paper does not establish a significant 20% reduction for dialysis initiation alone. Page numbers were not available in our copy. (LLM, conf=0.86)
plaindirectn = 13,191- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“For T2D and posttransplant diabetes, it is reasonable to treat kidney transplant recipients with metformin according to eGFR, as for the broader population with T2D, because risks of metformin are related to kidney function (80–84).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Glycemic Management for Patients With a Kidney Transplant
What the sources say
- Not checked — no full text of the sourcecites [80] Attallah, 2019, Use of empagliflozin in recipients of kidney transplant: a report of 8 cases, Transplant Proc source
- Could not verifycites [81] Cehic, 2019, Efficacy and safety of empagliflozin in the management of diabetes mellitus in heart transplant recipients, Transplant Direct sourceExperimental — accuracy not yet measured
The Results and Discussion (page numbers unavailable) mention metformin use among heart transplant recipients, but do not address metformin treatment in kidney transplant recipients. Searches for metformin with eGFR, renal function, and contraindications found no guidance on eGFR-based metformin use or evidence that its risks depend on kidney function. (LLM, conf=0.76)
- Not checked — no full text of the sourcecites [82] Halden, 2019, Efficacy and safety of empagliflozin in renal transplant recipients with posttransplant diabetes mellitus, Diabetes Care source
- Partly supportedcites [83] Mahling, 2019, Sodium-glucose cotransporter 2 (SGLT2) inhibition in kidney transplant recipients with diabetes mellitus, Kidney Blood Press Res sourceExperimental — accuracy not yet measured
Patient Characteristics (p. 3) reports that 20% of the kidney transplant recipients were already taking metformin, supporting its use in some recipients. But the paper does not recommend metformin treatment according to eGFR or say that metformin risks depend on kidney function; the eGFR eligibility threshold in Study Participants (p. 3) applies to SGLT2 inhibition, not metformin. (LLM, conf=0.78)
- Could not verifycites [84] Schwaiger, 2019, Empagliflozin in posttransplantation diabetes mellitus: a prospective, interventional pilot study on glucose metabolism, fluid volume, and patient safety, Am J Transplant sourceExperimental — accuracy not yet measured
The Results (Glycemic control through 4 weeks; page unavailable) mention metformin only as a drug one participant was taking before it was discontinued for the empagliflozin study. The Methods (Study design, patients, and procedures; page unavailable) set an eGFR eligibility threshold, but do not link kidney function to metformin risks or recommend eGFR-based metformin treatment. Searched the indexed copy for metformin and its relationship to eGFR and transplant recipients. (LLM, conf=0.76)
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Every source the paper cites for this claim was checked and supports it.
In the paper
“22% reduction in HF hospitalizations”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Renin-Angiotensin-Aldosterone System Inhibition
What the sources say
- Supportedcites [88] Agarwal, 2022, Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis, Eur Heart J source
The Discussion reports that, in the FIDELITY analysis, hospitalization for heart failure had a 22% relative risk reduction with finerenone versus placebo. The Results give the corresponding hazard ratio of 0.78 (95% CI, 0.66–0.92). (LLM, conf=0.95)
plaindirectn = 13,191- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“However, findings of a meta-analysis of the cardiovascular outcomes trials showed that ASCVD risk was reduced at least as much among individuals with eGFR <60 mL/min/1.73 m2 compared with those with higher eGFR (71).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Glycemic Management in Advanced CKD (eGFR <30 mL/min/1.73 m2 With or Without KRT)
What the sources say
- Partly supportedcites [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
The Discussion says cardiovascular benefit was consistent across subgroups, including patients with kidney disease. But the three-component MACE subgroup analysis reports a smaller point-estimated risk reduction for eGFR <60 than for eGFR ≥60 (HR 0.88 versus 0.83), so it does not establish that risk was reduced *at least as much* in the lower-eGFR group. The subgroup comparison was not statistically significant (p=0.52). (LLM, conf=0.88)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“In T2D, advanced CKD is a risk factor for hypoglycemia (29,79) and, when possible, drugs that control glycemia without increasing risk of hypoglycemia are preferred.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Glycemic Management in Advanced CKD (eGFR <30 mL/min/1.73 m2 With or Without KRT)
What the sources say
- Could not verifycites [29] de Boer, 2021, Rationale and design of the Kidney Precision Medicine Project, Kidney Int sourceExperimental — accuracy not yet measured
The Introduction discusses CKD in people with diabetes and lists cardiovascular events, infections, and mortality among CKD outcomes, but does not mention hypoglycemia. Searches for hypoglycemia in advanced CKD and for glycemic control found no passage addressing the claimed risk in T2D. The Study design section focuses on relatively early CKD rather than advanced CKD. (LLM, conf=0.72)
- Partly supportedcites [79] Pathak, 2016, Severe hypoglycemia requiring medical intervention in a large cohort of adults with diabetes receiving care in U.S. integrated health care delivery systems: 2005–2011, Diabetes Care sourceExperimental — accuracy not yet measured
The Results report substantially higher rates of severe hypoglycemia in patients with CKD than in those without it. However, the paper does not isolate advanced CKD, and its Study Population section says the cohort could not be separated by diabetes type, although approximately 95% were estimated to have T2D. The finding supports an association, not a demonstrated causal risk factor; page numbers are unavailable in our copy. (LLM, conf=0.88)
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Could not verify
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Moreover, SGLT2i have been observed to have consistent efficacy and safety across studied ranges of eGFR (56).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Glucose-Lowering Agents in T2D and CKD
What the sources say
- Partly supportedcites [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
The Overall section reports kidney benefits in every studied eGFR subgroup, although the relative benefit might attenuate at lower eGFR. It does not establish consistent safety across eGFR ranges: the reported reduction in acute kidney injury is an overall result, not an eGFR-subgroup safety analysis. Page numbers are unavailable in our copy. (LLM, conf=0.87)
plain- Asserted: passes — The authors put it forward as true.
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- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“23% for a composite outcome of doubling of creatinine, kidney failure, or renal death”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Renin-Angiotensin-Aldosterone System Inhibition
What the sources say
- Supportedcites [88] Agarwal, 2022, Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis, Eur Heart J source
The Results report a significantly lower incidence of the kidney composite with finerenone than placebo (HR 0.77; P = 0.0002), corresponding to a 23% relative risk reduction. The Methods identify the composite’s sustained ≥57% eGFR decrease as equivalent to doubling of serum creatinine. (LLM, conf=0.94)
plaindirectn = 13,191- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“demonstrated significant reductions of 18% for the composite cardiovascular outcome”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Renin-Angiotensin-Aldosterone System Inhibition
What the sources say
- Partly supportedcites [88] Agarwal, 2022, Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis, Eur Heart J sourceExperimental — accuracy not yet measured
The Results report a significant reduction in the composite cardiovascular outcome with finerenone, but the hazard ratio of 0.86 corresponds to a 14% reduction, not 18%. The Results also report 13,171 participants randomized and 13,026 included in the analyses, rather than 13,191. (LLM, conf=0.92)
boosteddirectn = 13,191- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“While <10% of participants were treated with an SGLT2i or a GLP-1 receptor agonist”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Renin-Angiotensin-Aldosterone System Inhibition
What the sources say
- Supportedcites [88] Agarwal, 2022, Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis, Eur Heart J source
The Results report that, at baseline, 6.7% of FIDELITY participants used an SGLT-2 inhibitor and 7.2% used a GLP-1 receptor agonist—each below 10%. The paper does not give a combined percentage of participants using either therapy. (LLM, conf=0.91)
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Finerenone was investigated in two complementary phase 3 studies of patients with T2D, kidney disease (defined primarily as ACR ≥30 mg/g), and potassium <4.8 mmol/L and is the only ns-MRA approved in the world for slowing CKD progression and reducing cardiovascular events.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Renin-Angiotensin-Aldosterone System Inhibition
What the sources say
- Partly supportedcites [86] Bakris, 2020, Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes, N Engl J Med sourceExperimental — accuracy not yet measured
The Patients section (page not provided) confirms type 2 diabetes, kidney disease defined using albumin-to-creatinine ratios beginning at 30 mg/g, and a screening potassium requirement. But it specifies potassium ≤4.8 mmol/L, not <4.8. The Discussion describes this paper’s phase 3 trial and mentions FIGARO-DKD as an ongoing complementary trial; it does not establish the stated eligibility criteria for both studies. (LLM, conf=0.88)
- Partly supportedcites [87] Pitt, 2021, Cardiovascular events with finerenone in kidney disease and type 2 diabetes, N Engl J Med sourceExperimental — accuracy not yet measured
The introduction describes two complementary phase 3 finerenone trials in patients with type 2 diabetes and CKD, and the Patients section gives an albumin-to-creatinine ratio starting at 30 mg/g for this trial. However, the Patients section specifies serum potassium of 4.8 mmol/L or less at screening, not strictly less than 4.8 mmol/L. The quoted claim also applies that threshold to both trials, which this passage does not establish. (LLM, conf=0.88)
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Serum potassium was monitored regularly, and 2.6% of participants stopped treatment because of hyperkalemia with finerenone compared with 0.9% on placebo (86).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Renin-Angiotensin-Aldosterone System Inhibition
What the sources say
- Partly supportedcites [86] Bakris, 2020, Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes, N Engl J Med sourceExperimental — accuracy not yet measured
The Trial Procedures section describes scheduled visits and potassium-based dose adjustments, supporting regular monitoring. Table 2 reports permanent discontinuation due to hyperkalemia in 2.3% of the finerenone group and 0.9% of the placebo group—not 2.6% and 0.9%. (LLM, conf=0.94)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“In fact, SGLT2i use appears to protect patients from AKI (56).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Glucose-Lowering Agents in T2D and CKD
What the sources say
- Supportedcites [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
The Overall section reports that SGLT2 inhibitors lowered acute kidney injury risk by 25%. The Discussion likewise describes protection against acute kidney injury, while noting that events were collected variably and were not adjudicated. (LLM, conf=0.94)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“The 2022 ADA Standards of Care and KDIGO 2022 guideline are aligned on issues of CKD screening and diagnosis, glycemia monitoring, lifestyle therapies, treatment goals, and pharmacologic management (1,2).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Conclusions
What the sources say
- Partly supportedcites [1] American Diabetes Association, 2022, Standards of Medical Care in Diabetes—2022, Diabetes Care sourceExperimental — accuracy not yet measured
The Introduction (p. 1) identifies this work as the 2022 ADA Standards of Care and says its recommendations include screening, diagnosis, treatment, and general treatment goals. It does not discuss the KDIGO 2022 guideline or establish alignment on CKD screening and diagnosis, glycemia monitoring, lifestyle therapies, treatment goals, or pharmacologic management. (LLM, conf=0.83)
- Partly supportedcites [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
The Introduction (p. 18) says an ADA–KDIGO consensus report demonstrates broad similarities between the societies’ evidence-based recommendations. It also says CKD screening and diagnosis are addressed in that consensus report but are not explicitly covered by the KDIGO guideline. Thus, the source supports broad alignment, but not the claim that the two guidelines align on screening and diagnosis. (LLM, conf=0.90)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Moreover, the risk of hyperkalemia was significantly reduced by the presence of an SGLT2i (89).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Renin-Angiotensin-Aldosterone System Inhibition
What the sources say
- Supportedcites [89] Agarwal, 2022, Hyperkalemia risk with finerenone: results from the FIDELIO-DKD trial, J Am Soc Nephrol source
The Results (page unavailable) identify baseline SGLT-2i use as associated with a lower risk of at least mild hyperkalemia. The Methods describe the analysis as identifying significant independent predictors. This supports the cited claim in the context of the trial’s post hoc analysis, although the Discussion cautions that few patients used an SGLT-2i at baseline. (LLM, conf=0.87)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“results of subgroup analyses suggested that benefits of finerenone were similar with and without concomitant SGLT2i or GLP-1 receptor agonist treatment.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Renin-Angiotensin-Aldosterone System Inhibition
What the sources say
- Supportedcites [88] Agarwal, 2022, Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis, Eur Heart J source
The Results report consistent cardiovascular outcomes in prespecified subgroups, including patients with and without baseline SGLT-2 inhibitor or GLP-1RA use. The Discussion says finerenone’s cardiovascular and kidney benefits were at least as large in patients taking either treatment as in those not taking them. No page numbers are provided in our copy. (LLM, conf=0.93)
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“In summary, FIDELIO-DKD and FIGARO-DKD demonstrated cardiovascular and kidney benefits for finerenone among people with T2D who were treated with standard of care (including an RAS inhibitor at maximally tolerated doses and good control of glycemia and BP) who were at high residual risk, based largely on albuminuria (ACR ≥30 mg/g).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Renin-Angiotensin-Aldosterone System Inhibition
What the sources say
- Partly supportedcites [86] Bakris, 2020, Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes, N Engl J Med sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
- Supportedcites [87] Pitt, 2021, Cardiovascular events with finerenone in kidney disease and type 2 diabetes, N Engl J Med source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“However, spironolactone causes hyperkalemia, particularly with reduced kidney function (i.e., eGFR <45 mL/min/1.73 m2).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Renin-Angiotensin-Aldosterone System Inhibition
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
In the paper
“Like CREDENCE and DAPA-CKD, EMPA-KIDNEY was stopped early for clear positive efficacy (63); corresponding expansion of the indications for use of an SGLT2i in CKD may be further supported based on these findings.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Glucose-Lowering Agents in T2D and CKD
What the sources say
- Not matchedcites [63] Boehringer Ingelheim . Jardiance (empagliflozin) Phase III EMPA-KIDNEY trial will stop early due to clear positive efficacy in people with chronic kidney disease, 2022. Accessed 16 March 2022. Available from https://www.boehringer-ingelheim.com/human-health/metabolic-diseases/early-stop-chronic-kidney-disease-trial-efficacy
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
boosteddirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“However, in moderate-to-severe CKD (CKD stages G3 and G4), rates of hypoglycemia are reduced by one-half even with concurrent insulin therapy (77).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Use of Additional Glucose-Lowering Agents
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
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“In cohort studies, risks of progressive CKD, cardiovascular events, and mortality all increase with categories of increasing albuminuria or decreasing eGFR.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Screening and Diagnosis
plaindirect- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Most patients with diabetes and CKD have high residual risks of CKD progression and cardiovascular disease despite treatment, and increasing options are available for risk mitigation.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Comprehensive Care > Goals of Comprehensive Care
plain- Asserted: passes — The authors put it forward as true.
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- Based: unclear — It is unclear why the paper says it holds.
In the paper
“Higher protein intakes confer theoretical risk of enhancing kidney function decline (35).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Comprehensive Care > Lifestyle
What the sources say
- Not matchedcites [35] Joint WHO/FAO/UNU Expert Consultation, 2007
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
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- Not matched
In the paper
“KDIGO has codified a CKD classification scheme based on eGFR and albuminuria that is endorsed by the ADA (26).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Screening and Diagnosis
What the sources say
- Not matchedcites [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.
plain- Asserted: passes — The authors put it forward as true.
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- Not matched
In the paper
“The American Society of Nephrology and National Kidney Foundation advocate using the 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, which was generated without inclusion of a term for race and calculates eGFR without regard to race, to estimate glomerular filtration rate (GFR) from creatinine, age, and sex (20).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Screening and Diagnosis
What the sources say
- Not checked — no full text of the sourcecites [20] Delgado, 2022, A unifying approach for GFR estimation: recommendations of the NKF-ASN Task Force on reassessing the inclusion of race in diagnosing kidney disease, Am J Kidney Dis source
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“In overweight or obese patients with diabetes, ADA and KDIGO show overall agreement with respect to achieving and maintaining healthy weight through diet, physical activity, and behavioral therapy (Supplementary Table 1).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Comprehensive Care > Lifestyle
What the sources say
- Not matchedcites (Supplementary Table 1)
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These benefits are independent of glycemia, and an SGLT2i should be used for patients with T2D and CKD even if glycemic targets are already attained.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Glucose-Lowering Agents in T2D and CKD
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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In the paper
“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).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Glucose-Lowering Agents in T2D and CKD
What the sources say
- Not matchedcites [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.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
In the paper
“Both the ADA and KDIGO emphasize use of individualized glycemic targets that take into consideration key patient characteristics that may modify risks and benefits of intensive glycemic control (Supplementary Table 1).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Glycemic Control
What the sources say
- Not matchedcites (Supplementary Table 1)
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Not matched
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Statin therapy is a cornerstone of therapy for the primary and secondary prevention of ASCVD among people with diabetes and CKD.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Lipid Management
What the sources say
- Not checked — no full text of the sourcecites [46] Wanner, 2014, KDIGO clinical practice guideline for lipid management in CKD: summary of recommendation statements and clinical approach to the patient, Kidney Int source
- Not checked — no full text of the sourcecites [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
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“These trials enrolled participants with albuminuria (ACR ≥300 mg/g and ≥200 mg/g, respectively); therefore, current evidence is strongest in this population, as emphasized by ADA recommendations (17) (Table 1).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Glucose-Lowering Agents in T2D and CKD
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
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Consequently, both guidelines emphasize the concurrent use of 1) HbA1c as a metric upon which therapeutic targets are defined based on randomized controlled trial (RCT) data, 2) continuous glucose monitoring (CGM) to assess effectiveness and safety of treatment among patients at risk for hypoglycemia or to assess overall glycemia when HbA1c is inaccurate, and 3) self-monitoring of blood glucose as”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Glycemic Control
What the sources say
- Not checked — no full text of the sourcecites [37] Draznin, 2022, 7. Diabetes technology: Standards of Medical Care in Diabetes—2022, Diabetes Care source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These effects appear to be additive, based on preclinical studies, to those of SGLT2i and GLP-1 receptor agonists, though further clinical research on these combinations is needed.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Renin-Angiotensin-Aldosterone System Inhibition
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- It may state two separate claims as one. 34
- Probably not a substantial claim. 33
The cited sources support only part of this claim — read each source’s verdict below.
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).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Background
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 supportedcites [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
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)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
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).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Screening and Diagnosis
What the sources say
- Partly supportedcites [23] Chen, 2019, Chronic kidney disease diagnosis and management: a review, JAMA sourceExperimental — accuracy not yet measured
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)
- Partly supportedcites [24] Hsu, 2021, Race, genetic ancestry, and estimating kidney function in CKD, N Engl J Med sourceExperimental — accuracy not yet measured
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)
- Could not verifycites [25] Levey, 2009, A new equation to estimate glomerular filtration rate, Ann Intern Med sourceExperimental — accuracy not yet measured
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)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
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).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Introduction
What the sources say
- Partly supportedcites [1] American Diabetes Association, 2022, Standards of Medical Care in Diabetes—2022, Diabetes Care sourceExperimental — accuracy not yet measured
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)
- Supportedcites [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
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)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“CKD occurring among people with diabetes is common, morbid, and costly.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Background
What the sources say
- Not matchedcites [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.
- Partly supportedcites [4] Afkarian, 2016, Clinical manifestations of kidney disease among US adults with diabetes, 1988-2014, JAMA sourceExperimental — accuracy not yet measured
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)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Not matched
The cited sources support only part of this claim — read each source’s verdict below.
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.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Comprehensive Care > Lifestyle
What the sources say
- Could not verifycites [1] American Diabetes Association, 2022, Standards of Medical Care in Diabetes—2022, Diabetes Care sourceExperimental — accuracy not yet measured
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)
- Partly supportedcites [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
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)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Could not verify
The cited sources support only part of this claim — read each source’s verdict below.
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).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Abstract
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 supportedcites [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
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)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Also stated in: § Background · plain
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
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).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Comprehensive Care > Education, Self-care, and Patient Empowerment
What the sources say
- Supportedcites [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 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)
- 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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
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).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Screening and Diagnosis
What the sources say
- Partly supportedcites [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
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)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Both the ADA and KDIGO recommend annual screening of patients with diabetes for CKD (17,18) (Fig. 1).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Screening and Diagnosis
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 supportedcites [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
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)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
Every source the paper cites for this claim was checked and supports it.
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.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Comprehensive Care > Goals of Comprehensive Care
What the sources say
- Supportedcites [1] American Diabetes Association, 2022, Standards of Medical Care in Diabetes—2022, Diabetes Care source
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)
- Supportedcites [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
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)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
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).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Comprehensive Care > Lifestyle
What the sources say
- Partly supportedcites [1] American Diabetes Association, 2022, Standards of Medical Care in Diabetes—2022, Diabetes Care sourceExperimental — accuracy not yet measured
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)
- Supportedcites [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
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)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“ACR has marked variability; therefore, a confirmatory urine sample within 3–6 months is recommended (26,27).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Screening and Diagnosis
What the sources say
- Not matchedcites [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.
- Supportedcites [27] KDOQI, 2007, KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease, Am J Kidney Dis source
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)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
- Not matched
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
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.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Glucose-Lowering Agents in T2D and CKD
What the sources say
- Supportedcites [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 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)
- 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
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
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).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Glycemic Control
What the sources say
- Partly supportedcites [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
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)
- 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 matchedcites (Supplementary Table 1)
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
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).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > BP Management
What the sources say
- Supportedcites [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
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)
plainn = 3- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
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).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Comprehensive Care > Lifestyle
What the sources say
- Could not verifycites [1] American Diabetes Association, 2022, Standards of Medical Care in Diabetes—2022, Diabetes Care sourceExperimental — accuracy not yet measured
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)
- Partly supportedcites [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
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)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Could not verify
Every source the paper cites for this claim was checked and supports it.
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).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > BP Management
What the sources say
- Supportedcites [40] American Diabetes Association Professional Practice Committee, 2022, 10. Cardiovascular disease and risk management: Standards of Medical Care in Diabetes—2022, Diabetes Care source
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)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Supported
The cited sources that could be checked couldn’t confirm or dispute this claim.
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.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Use of Additional Glucose-Lowering Agents
What the sources say
- Could not verifycites [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
Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.
- 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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Could not verify
Every source the paper cites for this claim was checked and supports it.
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).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Use of Additional Glucose-Lowering Agents
What the sources say
- Supportedcites [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
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)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
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).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Glucose-Lowering Agents in T2D and CKD
What the sources say
- Partly supportedcites [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
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
- 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 supportedcites [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
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Esaxerenone lowered BP and albuminuria with limited changes in potassium, but long-term studies with clinical end points are lacking (85).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Renin-Angiotensin-Aldosterone System Inhibition
What the sources say
- Partly supportedcites [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
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)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources that could be checked couldn’t confirm or dispute this claim.
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).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Use of Additional Glucose-Lowering Agents
What the sources say
- Could not verifycites [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
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)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Could not verify
The cited sources support only part of this claim — read each source’s verdict below.
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.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Conclusions
What the sources say
- Partly supportedcites [1] American Diabetes Association, 2022, Standards of Medical Care in Diabetes—2022, Diabetes Care sourceExperimental — accuracy not yet measured
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)
- Supportedcites [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 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)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Partly supported
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
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.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
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.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
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.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > BP Management
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
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).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Use of Additional Glucose-Lowering Agents
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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
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.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Renin-Angiotensin-Aldosterone System Inhibition
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
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.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Renin-Angiotensin-Aldosterone System Inhibition
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Comprehensive Care > Lifestyle
What the sources say
- Not matchedcites (Supplementary Table 1)
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
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).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Introduction
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Areas of consensus between the two guidelines therefore represent independent agreement on high priority areas of care.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Introduction
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
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.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Comprehensive Care > Lifestyle
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“For example, RAS inhibitors, SGLT2i, and the ns-MRA finerenone all cause initial hemodynamic reductions in GFR.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Comprehensive Care > Goals of Comprehensive Care
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“A joint writing group of ADA and KDIGO representatives convened to compare and contrast ADA and KDIGO recommendations.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Introduction
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
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.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
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.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Introduction
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
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.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Introduction
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
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).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > BP Management
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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
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.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Glycemic Control
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
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.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Glycemic Control
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
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).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Glucose-Lowering Agents in T2D and CKD
What the sources say
- Not matchedcites [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.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
None of the sources cited for this claim have been checked yet.
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.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > BP Management
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Though specific evidence is low, smoking cessation is also strongly advised.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Comprehensive Care > Lifestyle
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
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.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > BP Management
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
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”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Comprehensive Care > Lifestyle
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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
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).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Glycemic Control
What the sources say
- Not matchedcites (Supplementary Table 1)
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
- Not matched
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
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.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Glycemic Control
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
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.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Glycemic Control
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
In the paper
“All of these thresholds are proposed as starting places for individualization of targets (41).”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > BP Management
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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
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.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Renin-Angiotensin-Aldosterone System Inhibition
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Glycemic Management for Patients With a Kidney Transplant
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Treatment Targets and Pharmacotherapy > Glycemic Management for Patients With a Kidney Transplant
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This consensus approach to management is based on high-quality evidence.”
§ Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) > Conclusions
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
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).”
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?
The cited source doesn’t support the claim as written.
In the citing paper
“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]
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measured
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Compared with higher levels of dietary protein intake, this level slowed GFR decline with evidence of a greater effect over time.”
From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [1]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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 (1,13,14).”
From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [1]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“In this section, the focus is on CKD attributed to diabetes in adults, which occurs in 20-40% of people with diabetes (1)(2)(3)(4).”
From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [1]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“An eGFR persistently <60 mL/min/1.73m 2 and/or a urinary albumin value of >30 mg/g creatinine is considered abnormal, though optimal thresholds for clinical diagnosis are debated in older adults over the age of 70 years (1,18).”
From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [1]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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 (54,55) and type 2 diabetes (1,56,57).”
From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [1]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“For people with diabetes and chronic kidney disease, collaborative person-centered medical homes may decrease risk-adjusted readmission rates (197).”
From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [197]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Medication dosing may require modification with eGFR <60 mL/min/ 1.73 m 2 (1).”
From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [1]
The cited source says what the claim attributes to it.
In the citing paper
“Screening for albuminuria can be most easily performed by urine albumin-tocreatinine ratio (UACR) in a random spot urine collection (1).”
From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [1]
Citations
Cites
Toprak, Ö., Kurt, H., Sarı, Y., Şarkış, C., Us, H., & Kırık, A. (2017) · Kidney & Blood Pressure Research · doi:10.1159/000468530 · Cited by 29,772
A New Equation to Estimate Glomerular Filtration Rate
Levey, A. S., Stevens, L. A., Schmid, C. H., Zhang, Y. (., Castro, A. F., Feldman, H. I., Kusek, J. W., Eggers, P., Van Lente, F., Greene, T., et al. (2009) · Annals of Internal Medicine · doi:10.7326/0003-4819-150-9-200905050-00006 · Cited by 25,603
International Diabetes Federation 2017
Carracher, A. M., Marathe, P. H., & Close, K. L. (2018) · Journal of Diabetes · doi:10.1111/1753-0407.12644 · Cited by 13,379
Ahmed, A., Jorna, T., & Bhandari, S. (2016) · The Nephron journals/Nephron journals · doi:10.1159/000447068 · Cited by 11,782
KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease
Stevens, P. E., Ahmed, S. B., Carrero, J. J., Foster, B., Francis, A., Hall, R. K., Herrington, W. G., Hill, G., Inker, L. A., Kazancıoğlu, R., et al. (2024) · Kidney International · doi:10.1016/j.kint.2023.10.018 · Cited by 8,530
Brenner, B. M., Cooper, M. E., de Zeeuw, D., Keane, W. F., Mitch, W. E., Parving, H.-H., Remuzzi, G., Snapinn, S. M., Zhang, Z., & Shahinfar, S. (2001) · New England Journal of Medicine · doi:10.1056/nejmoa011161 · Cited by 7,493
Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes
Marso, S. P., Bain, S. C., Consoli, A., Eliaschewitz, F. G., Jódar, E., Leiter, L. A., Lingvay, I., Rosenstock, J., Seufert, J., Warren, M. L., et al. (2016) · New England Journal of Medicine · doi:10.1056/nejmoa1607141 · Cited by 6,900
Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy
Perkovic, V., Jardine, M. J., Neal, B., Bompoint, S., Heerspink, H. J. L., Charytan, D. M., Edwards, R., Agarwal, R., Bakris, G., Bull, S., et al. (2019) · New England Journal of Medicine · doi:10.1056/nejmoa1811744 · Cited by 6,189 · cited 1×
“982 and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation [CREDENCE] and Dapagliflozin And Prevention of Adverse outcomes in Chronic Kidney Disease [DAPA-CKD]) demonstrated significant benefit for composite outcomes including end points of substantial eGFR decline, kidney failure, and mortality…”
BackgroundSelf-citationDapagliflozin in Patients with Chronic Kidney Disease
Heerspink, H. J. L., Stefánsson, B. V., Correa-Rotter, R., Chertow, G. M., Greene, T., Hou, F.-F., Mann, J. F. E., McMurray, J. J. V., Lindberg, M., Rossing, P., et al. (2020) · New England Journal of Medicine · doi:10.1056/nejmoa2024816 · Cited by 5,618
Self-citationThe effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy
Lewis, E. J., Hunsicker, L. G., Bain, R. P., & Rohde, R. D. (1993) · New England Journal of Medicine · doi:10.1056/nejm199311113292004 · Cited by 5,394
Research works printed but not linked: 3
- United States Renal Data System, 2020, 2020 USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States
- Centers for Disease Control and Prevention, 2020, National Diabetes Statistics Report, 2020
- 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
McDonagh, T. A., Metra, M., Adamo, M., Gardner, R. S., Baumbach, A., Böhm, M., Burri, H., Butler, J., Čelutkienė, J., Chioncel, O., et al. (2023) · European Heart Journal · doi:10.1093/eurheartj/ehad195 · Cited by 2,612
Cardiovascular-kidney-metabolic health: a presidential advisory from the American Heart Association
Ndumele, C. E., Rangaswami, J., Chow, S. L., Neeland, I. J., Tuttle, K. R., Khan, S. S., Coresh, J., Mathew, R. O., Baker-Smith, C. M., Carnethon, M. R., et al. (2023) · Circulation · doi:10.1161/cir.0000000000001184 · Cited by 2,208
“121,139 In patients with a propensity for hyper-kalemia, the addition of an oral antihyperkalemic agent such as patiromer acetate or sodium zirconium cyclosili-cate may allow maintenance of an RAAS inhibitor without the risk of hyperkalemia.”
BackgroundSelf-citationEffects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes.
Perkovic, V., Tuttle, K. R., Rossing, P., Mahaffey, K. W., Mann, J. F. E., Bakris, G., Baeres, F. M. M., Idorn, T., Bosch-Traberg, H., Lausvig, N. L., et al. (2024) · New England Journal of Medicine · doi:10.1056/nejmoa2403347 · Cited by 2,099
Self-citationNdumele, C. E., Neeland, I. J., Tuttle, K. R., Chow, S. L., Mathew, R. O., Khan, S. S., Coresh, J., Baker-Smith, C. M., Carnethon, M. R., Després, J.-P., et al. (2023) · Circulation · doi:10.1161/cir.0000000000001186 · Cited by 1,405
“58,69,80 The Kidney Disease Improving Global Outcomes CKD staging system combines eGFR and albuminuria to provide a broad risk estimate for CKD progression, CVD events, and overall mortality.”
BackgroundSelf-citationBaigent, C., Emberson, J., Haynes, R., Herrington, W. G., Judge, P., Landray, M. J., Mayne, K. J., Ng, S. Y. A., Preiss, D., Roddick, A. J., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(22)02074-8 · Cited by 1,020
Metadata
- 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
- 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
- green
- www.ncbi.nlm.nih.gov
- 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.
A language model drew the claims from the paper on 2026-10-16, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-16 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (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.
What counts as a claim ›How we measure confidence ›How we check this ›
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