18 Jan 2023 • Published on the 10th of January, 2023 KDIGO has published an update that includes 13 graded recommendations and 52 “practice points” for clinicians. The updated guideline focuses particularly on sodium–glucose cotransporter-2 (SGLT-2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and the nonsteroidal mineralocorticoid-receptor antagonist finerenone. A focus on preserving kidney function and maintaining well-being is recommended using a layered approach to care, starting with a foundation of lifestyle interventions, self-management, and first-line pharmacotherapy (such as sodium–glucose cotransporter-2 inhibitors) demonstrated to improve clinical outcomes. To this are added additional drugs with heart and kidney protection, such as glucagon-like peptide-1 receptor agonists and nonsteroidal mineralocorticoid receptor antagonists, and interventions to control risk factors for CKD progression and cardiovascular events, such as blood pressure, glycemia, and lipids. The KDIGO layered approach includes the preference for starting new treatments one at a time and then reassessing response and residual risk to further refine therapy. To maximize the tolerability of combination treatments, the guideline recommends the serial introduction of medications that improve intrarenal hemodynamics. Ongoing monitoring is critical to ensuring that each patient ultimately receives the optimal therapeutic regimen. Source: Annals of Internal Medicine| Read full story