Updated chronic kidney disease management guidelines recommend SGLT2 inhibitors regardless of diabetes or kidney disease type

Embargoed for release until 5:00 p.m. ET on Monday 10 March 2025   

Follow @Annalsofim on X, Facebook, Instagram, threads, and Linkedin
Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.         
----------------------------      

1. Updated chronic kidney disease management guidelines recommend SGLT2 inhibitors regardless of diabetes or kidney disease type

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-01926

URL goes live when the embargo lifts          

The Kidney Disease: Improving Global Outcomes (KDIGO) organization updated its existing clinical practice guideline in 2024 on evaluation and management of chronic kidney disease (CKD) in adults and children. A summary of the guideline’s recommendations with the greatest evidence is published in Annals of Internal Medicine.

An Evidence Review Team from Johns Hopkins University conducted an evidence synthesis and meta-analysis of relevant studies published through July 2023. A working group comprised of nephrologists; primary care physicians; internal medicine physicians; persons living with CKD; and various other subject matter experts was comprised to help inform the clinical practice points and aid guideline development. The full guideline included 28 recommendations and 141 practice points and emphasizes the importance of tailored care at every stage of CKD. The new guidelines emphasize the role of cystatin C for better accuracy of glomerular filtration rate (GMR) when evaluating CKD. To reiterate the importance of early detection, especially for underserved populations, the guidelines recommend point-of-care-testing (POCT) for creatinine and urine albumin measurement in areas where lab access is limited. There was also strong evidence for the use of an individualized, risk-based approach using validated prediction equations, like the Kidney Failure Risk Equation, for the prediction of kidney failure. Sodium–glucose cotransporter-2 inhibitors (SGLT2i) are now recommended for persons with CKD with and without diabetes for both kidney and cardiovascular benefit. The guidelines also recommend statins for adults with CKD aged 50 and older and note that they also have a role to prevent cardiovascular disease in patients with CKD. The full KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease can be found at https://kdigo.org/guidelines/ckd-evaluation-and-management/ . 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Magdalena Madero, MD, please email madero.magdalena@gmail.com.

---------------------------- 

2. Review highlights the need to improve receipt of preventive services for people with disabilities

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-02446

Editorial: https://www.acpjournals.org/doi/10.7326/ANNALS-25-00374

URL goes live when the embargo lifts            

A systematic review examining barriers and facilitators for the receipt of preventive services and interventions to improve receipt of preventive services for people with disabilities highlights the need to improve access for these patients. The findings are published in Annals of Internal Medicine. 

Researchers from Oregon Health & Science University reviewed and summarized 74 studies on barriers and facilitators to receipt of preventive services and interventions to improve receipt of preventive services for people with disabilities. Barriers and facilitators were classified into seven general categories: environment level, person level, provider level, health care system level, accessibility of health care facility, accessible communication, and policy level. The types of disabilities evaluated include physical; cognitive, intellectual, or developmental; sensory; and serious psychiatric or mental illness. 60 studies reported on barriers to and/or facilitators of the receipt of 10 clinical preventive services, with most evidence related to breast and cervical cancer screening. The barriers and facilitators reported varied across preventative services and disability types. Some barriers, such as lack of transportation, discomfort with screening, and providers’ lack of knowledge about disability, were identified for many disability types. Whereas, other barriers were more specific to people with particular types of disability, such as inability to give informed consent or providers’ misconception about sexual activity (cognitive disabilities) and lack of accessible communication methods (sensory disability). 16 studies reported on the effectiveness of interventions to improve the receipt of clinical preventive services for people with various types of disability. Educational interventions delivered to patients, caregivers, and/or clinicians were most commonly studied, and the effects of these interventions were mixed. The researchers concluded that the findings underscore the mismatch between interventions studied and barriers and facilitators identified. The broad range of barriers reported in the studies reviewed suggests the potential benefit of using a broad conception of accessibility which includes barriers and facilitators of various types and also considers the potential combined and/or interactive effects of those diverse barriers and facilitators. 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author David I. Buckley, MD, MPH, please email Erik Robinson at robineri@ohsu.edu.  

---------------------------- 

Also new in this issue:

Gout

John D. FitzGerald MD, PhD

In the Clinic

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-03951