# ADA/KDIGO 2022 consensus report on diabetes management in CKD Guideline · id `cardio:guideline-ada-kdigo-2022-consensus` · Cardiovascular Atlas · release `5dcd9b263fe17744` (public) > General information from published sources, not medical advice, and not reviewed by clinicians. Check the cited source before relying on anything here. The atlas's own text and curation may be reused under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0, https://creativecommons.org/licenses/by-nc/4.0/): credit the atlas, and do not use it commercially. See the atlas About page. Text quoted from a source stays under that source's own terms, given as the source's reuse\_basis. The atlas's reuse terms do not cover it. The downloads list each quotation with its source in third\_party\_quotations. Also called: Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) Browse, organ or system: Kidneys; Metabolism Browse, condition area: Diabetes and metabolic disease; Kidney connections ## In plain language A consensus report from the American Diabetes Association and KDIGO, published in Diabetes Care in December 2022. A joint group of representatives of the two organizations drew consensus statements from the association's standards of care and the KDIGO 2022 guideline, for adults with diabetes and chronic kidney disease. They cover a comprehensive care plan built on lifestyle, and these medicines: a renin-angiotensin system blocker, a statin, metformin, an SGLT2 inhibitor, a GLP-1 receptor agonist and a nonsteroidal mineralocorticoid receptor antagonist. ## Technical summary Diabetes Care 2022;45(12):3075-3090, doi 10.2337/dci22-0027, PMID 36189689, PMC9870667. PubMed lists no correction. The PMC full text is in the Open Access subset under the American Diabetes Association's own licence for educational, not-for-profit use of the unaltered work, so this atlas restates the content in its own words and quotes nothing. The report is guidance, not a trial result: its consensus statements carry no class of recommendation or level of evidence, and it dates from 2022. The care pathway of this atlas follows its consensus statements and its screening text and adds none. It is a different document from the KDIGO guideline of 2022 recorded in this atlas, which could not be read in full; the finerenone limits that the guideline's record lacks come from this report. ## Claims, with the population each applies to ## Context: Adults with type 1 or type 2 diabetes and CKD (ADA/KDIGO 2022 consensus report) Recipient: Adult; Population: Adults with type 1 or type 2 diabetes and chronic kidney disease (CKD). The report defines CKD as an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m2, albuminuria (an albumin-to-creatinine ratio of 30 mg/g or more) or other signs of kidney damage that persist for at least 3 months. It gives no age limit.; Care setting: Not stated in the report.; Geography: Not stated in the report (a joint report of a US association and an international kidney organization); Life stage: Adults, as the report's introduction puts it (adults with diabetes and CKD); the report gives no age bounds; Follow-up: Not applicable (guidance context) ### The ADA/KDIGO consensus report says that everyone with type 1 or type 2 diabetes and CKD should have a comprehensive care plan that the care team and the person work out and agree together. The base of the plan is nutrition, exercise, stopping smoking and weight. Medicines aimed at preserving organ function are added on that base, together with other treatment chosen to reach targets for blood sugar, blood pressure and blood fats. - Category: Recommendation - Evidence stage: Guidance - Certainty: Certainty not assessed - Applies to: Recipient: Adult; Population: Adults with type 1 or type 2 diabetes and chronic kidney disease (CKD). The report defines CKD as an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m2, albuminuria (an albumin-to-creatinine ratio of 30 mg/g or more) or other signs of kidney damage that persist for at least 3 months. It gives no age limit.; Care setting: Not stated in the report.; Geography: Not stated in the report (a joint report of a US association and an international kidney organization); Life stage: Adults, as the report's introduction puts it (adults with diabetes and CKD); the report gives no age bounds; Follow-up: Not applicable (guidance context) - Limitations: The statement sets out a way of organizing care and names no particular medicine. The report's text adds that several treatments are usually needed, that they may need to be added one at a time with frequent checks, and that therapeutic inertia should be avoided. Only the PubMed record and the PMC full text were read. The report is joint ADA and KDIGO guidance drawn from the two organizations' 2022 guidelines, not a trial result, and its consensus statements carry no class of recommendation or level of evidence (the report points to the two organizations' own documents for those). It dates from 2022, so later trials and approvals are not covered. Its licence allows educational, not-for-profit use of the unaltered work, so this atlas restates the statement in its own words. PubMed lists no correction to the report (checked 2026-10-15). - Last checked: 2026-10-15 - Sources: 1. Supports: Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) (Guideline, edition Published in Diabetes Care 45(12):3075-3090 (December 2022 issue; online 3 October 2022). PubMed record and the PMC full text (PMC9870667, in the PMC Open Access subset), both fetched 2026-10-15. PubMed lists no correction to the report. The same report was also published in Kidney International (PMID 36202661), which is not recorded as a separate source. The report is a joint consensus document that draws on the ADA Standards of Medical Care in Diabetes and the KDIGO 2022 guideline; it is a different document from either.) Locator: Goals of Comprehensive Care, Consensus Statement. Retrieved 2026-10-15T15:38:41Z. Source state: Current. Snapshot hash: 18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7. How it applies: The consensus statement on a comprehensive plan. 2. Supports: Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) (Guideline, edition Published in Diabetes Care 45(12):3075-3090 (December 2022 issue; online 3 October 2022). PubMed record and the PMC full text (PMC9870667, in the PMC Open Access subset), both fetched 2026-10-15. PubMed lists no correction to the report. The same report was also published in Kidney International (PMID 36202661), which is not recorded as a separate source. The report is a joint consensus document that draws on the ADA Standards of Medical Care in Diabetes and the KDIGO 2022 guideline; it is a different document from either.) Locator: Goals of Comprehensive Care, para 4 (therapeutic inertia). Retrieved 2026-10-15T15:38:41Z. Source state: Current. Snapshot hash: 18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7. How it applies: Several treatments, added in turn; avoid therapeutic inertia. 3. Background: Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) (Guideline, edition Published in Diabetes Care 45(12):3075-3090 (December 2022 issue; online 3 October 2022). PubMed record and the PMC full text (PMC9870667, in the PMC Open Access subset), both fetched 2026-10-15. PubMed lists no correction to the report. The same report was also published in Kidney International (PMID 36202661), which is not recorded as a separate source. The report is a joint consensus document that draws on the ADA Standards of Medical Care in Diabetes and the KDIGO 2022 guideline; it is a different document from either.) Locator: Introduction, para 4 (level of evidence). Retrieved 2026-10-15T15:38:41Z. Source state: Current. Snapshot hash: 18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7. How it applies: The consensus statements carry no level of evidence. ## Context: Adults with diabetes, high blood pressure and albuminuria (ADA/KDIGO 2022 consensus report) Recipient: Adult; Population: Adults with type 1 or type 2 diabetes who have high blood pressure and albuminuria. The report speaks of adults and gives no age bounds.; Care setting: Not stated in the report.; Geography: Not stated in the report (a joint report of a US association and an international kidney organization); Life stage: Adults, as the report's introduction puts it (adults with diabetes and CKD); the report gives no age bounds; Follow-up: Not applicable (guidance context) ### The ADA/KDIGO consensus report recommends an ACE inhibitor or an angiotensin receptor blocker (ARB) for people with type 1 or type 2 diabetes who have high blood pressure and albuminuria. The dose is raised to the largest dose that lowers blood pressure and that the person can tolerate. - Category: Recommendation - Evidence stage: Guidance - Certainty: Certainty not assessed - Applies to: Recipient: Adult; Population: Adults with type 1 or type 2 diabetes who have high blood pressure and albuminuria. The report speaks of adults and gives no age bounds.; Care setting: Not stated in the report.; Geography: Not stated in the report (a joint report of a US association and an international kidney organization); Life stage: Adults, as the report's introduction puts it (adults with diabetes and CKD); the report gives no age bounds; Follow-up: Not applicable (guidance context) - Limitations: The statement applies only to people who have both high blood pressure and albuminuria. The report's text advises against combining an ACE inhibitor with an ARB for long-term use, because studies over longer periods found no gain and more adverse events. It says evidence for treating people who have albuminuria with normal blood pressure is less strong. Only the PubMed record and the PMC full text were read. The report is joint ADA and KDIGO guidance drawn from the two organizations' 2022 guidelines, not a trial result, and its consensus statements carry no class of recommendation or level of evidence (the report points to the two organizations' own documents for those). It dates from 2022, so later trials and approvals are not covered. Its licence allows educational, not-for-profit use of the unaltered work, so this atlas restates the statement in its own words. PubMed lists no correction to the report (checked 2026-10-15). - Last checked: 2026-10-15 - Sources: 1. Supports: Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) (Guideline, edition Published in Diabetes Care 45(12):3075-3090 (December 2022 issue; online 3 October 2022). PubMed record and the PMC full text (PMC9870667, in the PMC Open Access subset), both fetched 2026-10-15. PubMed lists no correction to the report. The same report was also published in Kidney International (PMID 36202661), which is not recorded as a separate source. The report is a joint consensus document that draws on the ADA Standards of Medical Care in Diabetes and the KDIGO 2022 guideline; it is a different document from either.) Locator: BP Management, Consensus Statement. Retrieved 2026-10-15T15:38:41Z. Source state: Current. Snapshot hash: 18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7. How it applies: The consensus statement on an ACE inhibitor or ARB. 2. Supports: Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) (Guideline, edition Published in Diabetes Care 45(12):3075-3090 (December 2022 issue; online 3 October 2022). PubMed record and the PMC full text (PMC9870667, in the PMC Open Access subset), both fetched 2026-10-15. PubMed lists no correction to the report. The same report was also published in Kidney International (PMID 36202661), which is not recorded as a separate source. The report is a joint consensus document that draws on the ADA Standards of Medical Care in Diabetes and the KDIGO 2022 guideline; it is a different document from either.) Locator: ACE Inhibitors and ARBs, para 2 (combination, normal blood pressure). Retrieved 2026-10-15T15:38:41Z. Source state: Current. Snapshot hash: 18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7. How it applies: Avoid the combination; weaker evidence when blood pressure is normal. 3. Background: Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) (Guideline, edition Published in Diabetes Care 45(12):3075-3090 (December 2022 issue; online 3 October 2022). PubMed record and the PMC full text (PMC9870667, in the PMC Open Access subset), both fetched 2026-10-15. PubMed lists no correction to the report. The same report was also published in Kidney International (PMID 36202661), which is not recorded as a separate source. The report is a joint consensus document that draws on the ADA Standards of Medical Care in Diabetes and the KDIGO 2022 guideline; it is a different document from either.) Locator: Introduction, para 4 (level of evidence). Retrieved 2026-10-15T15:38:41Z. Source state: Current. Snapshot hash: 18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7. How it applies: The consensus statements carry no level of evidence. ## Context: Adults with diabetes, screened for CKD (ADA/KDIGO 2022 consensus report) Recipient: Adult; Population: Adults with type 1 or type 2 diabetes who have not yet been found to have chronic kidney disease (CKD), and those who have it. The report speaks of adults and gives no age bounds.; Care setting: Not stated in the report.; Geography: Not stated in the report (a joint report of a US association and an international kidney organization); Life stage: Adults, as the report's introduction puts it (adults with diabetes and CKD); the report gives no age bounds; Follow-up: Not applicable (guidance context) ### The ADA/KDIGO consensus report says that both organizations recommend screening people with diabetes for chronic kidney disease (CKD) every year, with a urine albumin test and an estimated glomerular filtration rate (eGFR). Screening starts at diagnosis in type 2 diabetes and 5 years after diagnosis in type 1 diabetes. The report defines CKD as an eGFR below 60 mL/min/1.73 m2, albuminuria (an albumin-to-creatinine ratio of 30 mg/g or more) or other signs of kidney damage, and says the finding must persist for at least 3 months before the diagnosis is made. - Category: Description - Evidence stage: Guidance - Certainty: Certainty not assessed - Applies to: Recipient: Adult; Population: Adults with type 1 or type 2 diabetes who have not yet been found to have chronic kidney disease (CKD), and those who have it. The report speaks of adults and gives no age bounds.; Care setting: Not stated in the report.; Geography: Not stated in the report (a joint report of a US association and an international kidney organization); Life stage: Adults, as the report's introduction puts it (adults with diabetes and CKD); the report gives no age bounds; Follow-up: Not applicable (guidance context) - Limitations: The report adds that screening is underused, especially for albuminuria, and that abnormal results should be confirmed. It gives no screening interval other than annual. This is guidance on screening, not evidence that screening improves outcomes. Only the PubMed record and the PMC full text were read. The report is joint ADA and KDIGO guidance drawn from the two organizations' 2022 guidelines, not a trial result, and its consensus statements carry no class of recommendation or level of evidence (the report points to the two organizations' own documents for those). It dates from 2022, so later trials and approvals are not covered. Its licence allows educational, not-for-profit use of the unaltered work, so this atlas restates the statement in its own words. PubMed lists no correction to the report (checked 2026-10-15). - Last checked: 2026-10-15 - Sources: 1. Supports: Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) (Guideline, edition Published in Diabetes Care 45(12):3075-3090 (December 2022 issue; online 3 October 2022). PubMed record and the PMC full text (PMC9870667, in the PMC Open Access subset), both fetched 2026-10-15. PubMed lists no correction to the report. The same report was also published in Kidney International (PMID 36202661), which is not recorded as a separate source. The report is a joint consensus document that draws on the ADA Standards of Medical Care in Diabetes and the KDIGO 2022 guideline; it is a different document from either.) Locator: Screening and Diagnosis, para 2 (annual screening). Retrieved 2026-10-15T15:38:41Z. Source state: Current. Snapshot hash: 18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7. How it applies: Annual screening. 2. Supports: Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) (Guideline, edition Published in Diabetes Care 45(12):3075-3090 (December 2022 issue; online 3 October 2022). PubMed record and the PMC full text (PMC9870667, in the PMC Open Access subset), both fetched 2026-10-15. PubMed lists no correction to the report. The same report was also published in Kidney International (PMID 36202661), which is not recorded as a separate source. The report is a joint consensus document that draws on the ADA Standards of Medical Care in Diabetes and the KDIGO 2022 guideline; it is a different document from either.) Locator: Screening and Diagnosis, para 2 (start of screening). Retrieved 2026-10-15T15:38:41Z. Source state: Current. Snapshot hash: 18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7. How it applies: Start of screening in type 2 and type 1 diabetes. 3. Supports: Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) (Guideline, edition Published in Diabetes Care 45(12):3075-3090 (December 2022 issue; online 3 October 2022). PubMed record and the PMC full text (PMC9870667, in the PMC Open Access subset), both fetched 2026-10-15. PubMed lists no correction to the report. The same report was also published in Kidney International (PMID 36202661), which is not recorded as a separate source. The report is a joint consensus document that draws on the ADA Standards of Medical Care in Diabetes and the KDIGO 2022 guideline; it is a different document from either.) Locator: Figure 1 caption. Retrieved 2026-10-15T15:38:41Z. Source state: Current. Snapshot hash: 18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7. How it applies: Screening includes both urine albumin and eGFR; persistent abnormality diagnoses CKD. 4. Supports: Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) (Guideline, edition Published in Diabetes Care 45(12):3075-3090 (December 2022 issue; online 3 October 2022). PubMed record and the PMC full text (PMC9870667, in the PMC Open Access subset), both fetched 2026-10-15. PubMed lists no correction to the report. The same report was also published in Kidney International (PMID 36202661), which is not recorded as a separate source. The report is a joint consensus document that draws on the ADA Standards of Medical Care in Diabetes and the KDIGO 2022 guideline; it is a different document from either.) Locator: Screening and Diagnosis, para 1 (definition). Retrieved 2026-10-15T15:38:41Z. Source state: Current. Snapshot hash: 18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7. How it applies: CKD definition and the 3-month persistence rule. 5. Background: Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) (Guideline, edition Published in Diabetes Care 45(12):3075-3090 (December 2022 issue; online 3 October 2022). PubMed record and the PMC full text (PMC9870667, in the PMC Open Access subset), both fetched 2026-10-15. PubMed lists no correction to the report. The same report was also published in Kidney International (PMID 36202661), which is not recorded as a separate source. The report is a joint consensus document that draws on the ADA Standards of Medical Care in Diabetes and the KDIGO 2022 guideline; it is a different document from either.) Locator: Introduction, para 4 (level of evidence). Retrieved 2026-10-15T15:38:41Z. Source state: Current. Snapshot hash: 18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7. How it applies: The consensus statements carry no level of evidence. ## Context: Adults with type 2 diabetes and CKD with an eGFR of 30 or more (ADA/KDIGO 2022 consensus report) Recipient: Adult; Population: Adults who have both type 2 diabetes and chronic kidney disease and an estimated glomerular filtration rate (eGFR) of 30 mL/min/1.73 m2 or higher. The report speaks of adults and gives no age bounds.; Care setting: Not stated in the report.; Geography: Not stated in the report (a joint report of a US association and an international kidney organization); Life stage: Adults, as the report's introduction puts it (adults with diabetes and CKD); the report gives no age bounds; Follow-up: Not applicable (guidance context) ### The ADA/KDIGO consensus report recommends metformin for people with type 2 diabetes and CKD whose eGFR is 30 mL/min/1.73 m2 or higher. It says to lower the dose to 1,000 mg a day when eGFR is 30 to 44, and for some people with an eGFR of 45 to 59 whose risk of lactic acidosis is high. - Category: Recommendation - Evidence stage: Guidance - Certainty: Certainty not assessed - Applies to: Recipient: Adult; Population: Adults who have both type 2 diabetes and chronic kidney disease and an estimated glomerular filtration rate (eGFR) of 30 mL/min/1.73 m2 or higher. The report speaks of adults and gives no age bounds.; Care setting: Not stated in the report.; Geography: Not stated in the report (a joint report of a US association and an international kidney organization); Life stage: Adults, as the report's introduction puts it (adults with diabetes and CKD); the report gives no age bounds; Follow-up: Not applicable (guidance context) - Limitations: The statement concerns metformin only when eGFR is 30 or higher; the report's text deals separately with lower kidney function. This atlas has no metformin record, so the claim sits on the report's own record. Only the PubMed record and the PMC full text were read. The report is joint ADA and KDIGO guidance drawn from the two organizations' 2022 guidelines, not a trial result, and its consensus statements carry no class of recommendation or level of evidence (the report points to the two organizations' own documents for those). It dates from 2022, so later trials and approvals are not covered. Its licence allows educational, not-for-profit use of the unaltered work, so this atlas restates the statement in its own words. PubMed lists no correction to the report (checked 2026-10-15). - Last checked: 2026-10-15 - Sources: 1. Supports: Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) (Guideline, edition Published in Diabetes Care 45(12):3075-3090 (December 2022 issue; online 3 October 2022). PubMed record and the PMC full text (PMC9870667, in the PMC Open Access subset), both fetched 2026-10-15. PubMed lists no correction to the report. The same report was also published in Kidney International (PMID 36202661), which is not recorded as a separate source. The report is a joint consensus document that draws on the ADA Standards of Medical Care in Diabetes and the KDIGO 2022 guideline; it is a different document from either.) Locator: ADA/KDIGO Consensus Statements, item 4 (metformin). Retrieved 2026-10-15T15:38:41Z. Source state: Current. Snapshot hash: 18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7. How it applies: The consensus statement on metformin and its dose limits. 2. Background: Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) (Guideline, edition Published in Diabetes Care 45(12):3075-3090 (December 2022 issue; online 3 October 2022). PubMed record and the PMC full text (PMC9870667, in the PMC Open Access subset), both fetched 2026-10-15. PubMed lists no correction to the report. The same report was also published in Kidney International (PMID 36202661), which is not recorded as a separate source. The report is a joint consensus document that draws on the ADA Standards of Medical Care in Diabetes and the KDIGO 2022 guideline; it is a different document from either.) Locator: Introduction, para 4 (level of evidence). Retrieved 2026-10-15T15:38:41Z. Source state: Current. Snapshot hash: 18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7. How it applies: The consensus statements carry no level of evidence. ## Connected pages - Co-issuer, with KDIGO (title): American Diabetes Association (`cardio:ada`) - Co-issuer, with the American Diabetes Association (title): Kidney Disease: Improving Global Outcomes (KDIGO) (`cardio:kdigo`) ## Provenance Content hash: 2916149d73062a251df7be571030881ec9041a9bcd302a578f26f0ca7e0f5548 Last substantive edit: 2026-10-15 Evidence last checked: 2026-10-15