{
  "release_id": "73130c34862e2d06",
  "id": "cardio:pathway-ckd-type-2-diabetes",
  "owner": "cardio",
  "kind": "care_pathway",
  "slug": "pathway-ckd-type-2-diabetes",
  "name": "Kidney and heart protection in diabetes and chronic kidney disease",
  "aliases": [],
  "atlases": [
    "cardio"
  ],
  "summary_plain": "The steps that a joint consensus report from the American Diabetes Association and KDIGO gives for protecting the kidneys and heart in adults with diabetes and chronic kidney disease: screen every year and agree a comprehensive care plan built on lifestyle, then add medicines in turn: a blood pressure medicine when albuminuria is present, a statin, metformin, an SGLT2 inhibitor, a GLP-1 receptor agonist if needed, and finerenone for some people with type 2 diabetes and albuminuria.",
  "summary_technical": "Care pathway built only from the 2022 consensus report (PubMed record and PMC full text, hash only, cite only), using its consensus statements and its screening text, not the full guidelines of the two organizations. Each step cites one claim, which carries its own limits. The report also covers goals and monitoring of blood sugar, advanced kidney disease, transplant and other details, which are not recorded here, and it dates from 2022, so later trials and approvals are not covered. The care team and the person decide what applies to the person.",
  "editorial_state": "draft",
  "last_substantive_edit": "2026-10-15",
  "last_evidence_check": "2026-10-15",
  "next_review_due": null,
  "identifiers": [],
  "navigation": {
    "cardio": {
      "system": [
        "kidneys",
        "metabolism"
      ],
      "condition-area": [
        "kidney-connections",
        "diabetes-and-metabolic-disease"
      ]
    }
  },
  "payload": {
    "applicability": "cardio:ctx-ada-kdigo-2022-diabetes-and-ckd",
    "steps": [
      {
        "label": "Screen for kidney disease",
        "description": "Every year, people with diabetes have a urine albumin test and an eGFR blood test. Screening starts at diagnosis in type 2 diabetes and 5 years after diagnosis in type 1 diabetes. An abnormal result is confirmed, and kidney disease is diagnosed when it stays abnormal for at least 3 months.",
        "branch_condition": "People with type 1 or type 2 diabetes",
        "claims": [
          "cardio:claim-ada-kdigo-2022-screening"
        ]
      },
      {
        "label": "Agree a comprehensive care plan",
        "description": "The care team and the person agree a plan that starts with nutrition, exercise, stopping smoking and weight, and adds medicines aimed at preserving organ function, and treatment to reach targets for blood sugar, blood pressure and blood fats.",
        "branch_condition": "Type 1 or type 2 diabetes with CKD",
        "claims": [
          "cardio:claim-ada-kdigo-2022-comprehensive-plan"
        ]
      },
      {
        "label": "Treat high blood pressure with a renin-angiotensin system blocker",
        "description": "An ACE inhibitor or an angiotensin receptor blocker is recommended, raised to the largest dose that lowers blood pressure and can be tolerated.",
        "branch_condition": "Type 1 or type 2 diabetes with high blood pressure and albuminuria",
        "claims": [
          "cardio:claim-ada-kdigo-2022-ace-inhibitor-or-arb"
        ]
      },
      {
        "label": "Add a statin",
        "description": "A statin is recommended, at moderate intensity to prevent a first atherosclerotic cardiovascular event and at high intensity for people who already have such disease and some people with several risk factors for it.",
        "branch_condition": "Type 1 or type 2 diabetes with CKD; the report notes a possible exception for first-event prevention in people on dialysis",
        "claims": [
          "cardio:claim-ada-kdigo-2022-statin"
        ]
      },
      {
        "label": "Use metformin when kidney function allows",
        "description": "Metformin is recommended when eGFR is 30 or higher, at a lower dose of 1,000 mg a day when eGFR is 30 to 44 and in some people with an eGFR of 45 to 59 whose risk of lactic acidosis is high.",
        "branch_condition": "Type 2 diabetes with CKD and an eGFR of 30 mL/min/1.73 m2 or higher",
        "claims": [
          "cardio:claim-ada-kdigo-2022-metformin"
        ]
      },
      {
        "label": "Add an SGLT2 inhibitor",
        "description": "Choose an SGLT2 inhibitor whose kidney or cardiovascular benefit has been shown; it can be continued if eGFR later falls below the starting level.",
        "branch_condition": "Type 2 diabetes with CKD and an eGFR of 20 mL/min/1.73 m2 or higher",
        "claims": [
          "cardio:claim-ada-kdigo-2022-sglt2-inhibitor"
        ]
      },
      {
        "label": "Add a GLP-1 receptor agonist if blood sugar is not at target",
        "description": "Choose a GLP-1 receptor agonist whose cardiovascular benefit has been shown.",
        "branch_condition": "Type 2 diabetes with CKD, blood sugar not at the individual target with metformin or an SGLT2 inhibitor, or those medicines cannot be used",
        "claims": [
          "cardio:claim-ada-kdigo-2022-glp-1-receptor-agonist"
        ]
      },
      {
        "label": "Consider a nonsteroidal MRA (finerenone)",
        "description": "Choose a nonsteroidal mineralocorticoid receptor antagonist whose kidney and cardiovascular benefit has been shown. The report names finerenone as the only one with that proof when it was written.",
        "branch_condition": "Type 2 diabetes, eGFR of 25 mL/min/1.73 m2 or higher, normal potassium and albuminuria (albumin-to-creatinine ratio of 30 mg/g or more) despite the largest tolerated dose of a renin-angiotensin system inhibitor",
        "claims": [
          "cardio:claim-ada-kdigo-2022-ns-mra-finerenone"
        ]
      }
    ]
  },
  "content_digest": "4cd230f8b96d07046f422fe14672b2c702fb9b67f0b672fd39418866a4ddadd4",
  "review": {
    "content_digest": "4cd230f8b96d07046f422fe14672b2c702fb9b67f0b672fd39418866a4ddadd4",
    "current": [],
    "conflicting": [],
    "stale": [],
    "inactive": []
  },
  "claims": [],
  "decisions": [],
  "milestones": [],
  "relationships": {
    "outgoing": [
      {
        "predicate": "related_to",
        "label": "The condition this pathway addresses",
        "clinical_claim_not_fact": false,
        "family": "navigation",
        "other_entity_id": "cardio:chronic-kidney-disease",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "related_to",
        "label": "The diabetes this pathway addresses",
        "clinical_claim_not_fact": false,
        "family": "navigation",
        "other_entity_id": "cardio:type-2-diabetes",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "related_to",
        "label": "A medicine in the pathway",
        "clinical_claim_not_fact": false,
        "family": "navigation",
        "other_entity_id": "cardio:finerenone",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      }
    ],
    "incoming": []
  },
  "page_path": "care-pathways/pathway-ckd-type-2-diabetes/",
  "context_path": "api/v1/context/cardio--pathway-ckd-type-2-diabetes.md"
}