KDIGO Guidelines

KDIGO Guidelines

ASN Kidney News gratefully acknowledges the editors of this special section, Kidney News Editorial Board member Edgar V. Lerma, MD, and KDIGO Chief Scientific Officer Michael Cheung, for their invaluable expertise in the preparation of this issue.

Over the past decade, Kidney Disease: Improving Global Outcomes (KDIGO) has established as a leading global force in making observations about the practice of kidney health care and in synthesizing recommendations for best practices. This has occurred through staging Controversies Conferences with global experts and practitioners on relevant topics in kidney health, developing Clinical Practice Guidelines, and building a portfolio of Implementation Programs through which the products from the aforementioned two activities are interpreted and discussed in the local or regional context.

“Rules are for the guidance of wise men and the obedience of fools.” Group Captain Sir Douglas Bader, 1910–1982

The complex interplay between the kidney and the heart where one organ dysfunction can initiate or accelerate the decline of the other was recently addressed at a KDIGO Controversies Conference on the prevention, diagnosis, and management of heart failure in kidney disease (1).

My involvement with KDIGO began a decade ago. In December 2009, international co-chairs Bertram Kasiske, MD, and Prof. Dr. Kai-Uwe Eckardt invited me to co-chair a Controversies Conference on cardiovascular disease in chronic kidney disease (CKD) with Professor Eberhard Ritz.

It is now seven years since the KDIGO guideline on anemia management in chronic kidney disease (CKD) was published in August 2012 (1). To accuse KDIGO of being lazy and idle in generating any updates or revisions would be inappropriate on two accounts.

In November 2017, KDIGO hosted a Controversies Conference in Singapore on glomerular diseases. The goal was to determine the best practice and evidence gaps in the treatment of glomerular diseases, review the key literature published since the 2012 KDIGO Glomerulonephritis (GN) Guideline, identify topics or issues for future guideline updating, and outline unmet needs in the management of GN (1, 2).

In 2012, KDIGO issued a clinical practice guideline for the management of blood pressure in chronic kidney disease (CKD) which excluded patients receiving maintenance dialysis. This guideline is now being revised on the basis of new clinical trial evidence, particularly from SPRINT, SPS3, and others. A multidisciplinary KDIGO guideline panel of clinical and scientific experts has convened in person and over teleconferences to discuss the excellent work of the Evidence Review Team with the aim to publish an update to the 2012 guideline in 2020.

Diabetes treatment has advanced rapidly over the past decade, with new drugs and technologies developed and translated into clinical care. Many of these treatments affect the kidney, are affected by chronic kidney disease (CKD), or carry both effects. In addition, new data have been published on foundational elements of care for people with diabetes and CKD, including lifestyle, ascertainment of glycemia, glycemic targets, and use of renin-angiotensin system (RAS) inhibitors.

Since the advent of the successful practice of living donor kidney transplantation more than 60 years ago, over 150,000 healthy persons in the United States have donated a kidney to help a family member, a friend, or even a stranger. Currently, more than 30,000 living kidney donations are performed worldwide each year. Living donor transplantation is clearly established as the best treatment option for kidney failure, offering patients the best chance of long-term dialysis-free survival, with a better quality of life, at lowest costs to the healthcare system.

The Kidney Disease: Improving Global Outcomes (KDIGO) 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD) represented a selective update of the prior CKD-MBD guideline published in 2009 (1, 2). The guideline update, along with the original 2009 publication, is intended to assist physicians, especially nephrologists, who care for CKD patients, including those using long-term dialysis therapy and individuals with a kidney transplant.

The 2008 KDIGO guideline on the prevention, diagnosis, evaluation, and treatment of hepatitis C virus (HCV) infection in patients with chronic kidney disease (CKD) was the very first guideline produced by KDIGO. Since then, there have been dramatic changes in the field of antiviral treatments, which prompted a timely reassessment and publication of this guideline update in 2018 (1). The purpose of this short review is to summarize the key recommendations from this important guidance document.