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ADA/KDIGO 2022 consensus report on diabetes management in CKD

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.

Also called Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO)

  • Guideline
  • In this atlas

Overview

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.

About this guideline

Edition
2022 consensus report
Published
2022-12
Status
Not checked for a newer edition
Scope
Management of diabetes in people with chronic kidney disease: screening and diagnosis, comprehensive care, blood pressure, blood fats and medicines for blood sugar and kidney protection.

Source

Document
Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO)
Publisher
Diabetes Care
Edition note
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.

Recommendations

Claims and 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)
Eligibility: 3 inclusion criteria; exclusion criteria not stated
Included
  • Type 1 or type 2 diabetes
  • High blood pressure
  • Albuminuria
Excluded
None stated

  • Recommendation Guidance Certainty not assessed

    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.

    Applies to Adult
    • 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.
    • Not stated in the report.
    • Not stated in the report (a joint report of a US association and an international kidney organization)
    • 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)
    Certainty method
    Not assessed
    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
    Next evidence check due
    Not scheduled
    Sources and citations (3)

    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 · Diabetes Care · 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. · Published 2022-12-01 · DOI: 10.2337/dci22-0027 · PMID: 36189689 · PMCID: PMC9870667

      Locator
      BP Management, Consensus Statement
      How it applies
      The consensus statement on an ACE inhibitor or ARB.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7
      Reuse basis
      PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.

    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 · Diabetes Care · 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. · Published 2022-12-01 · DOI: 10.2337/dci22-0027 · PMID: 36189689 · PMCID: PMC9870667

      Locator
      ACE Inhibitors and ARBs, para 2 (combination, normal blood pressure)
      How it applies
      Avoid the combination; weaker evidence when blood pressure is normal.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7
      Reuse basis
      PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.

    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 · Diabetes Care · 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. · Published 2022-12-01 · DOI: 10.2337/dci22-0027 · PMID: 36189689 · PMCID: PMC9870667

      Locator
      Introduction, para 4 (level of evidence)
      How it applies
      The consensus statements carry no level of evidence.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7
      Reuse basis
      PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.

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)
Eligibility: 2 inclusion criteria; exclusion criteria not stated
Included
  • Type 2 diabetes (screening starts at diagnosis)
  • Type 1 diabetes (screening starts 5 years after diagnosis)
Excluded
None stated

  • Description Guidance Certainty not assessed

    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.

    Applies to Adult
    • 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.
    • Not stated in the report.
    • Not stated in the report (a joint report of a US association and an international kidney organization)
    • 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)
    Certainty method
    Not assessed
    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
    Next evidence check due
    Not scheduled
    Sources and citations (5)

    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 · Diabetes Care · 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. · Published 2022-12-01 · DOI: 10.2337/dci22-0027 · PMID: 36189689 · PMCID: PMC9870667

      Locator
      Screening and Diagnosis, para 2 (annual screening)
      How it applies
      Annual screening.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7
      Reuse basis
      PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.

    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 · Diabetes Care · 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. · Published 2022-12-01 · DOI: 10.2337/dci22-0027 · PMID: 36189689 · PMCID: PMC9870667

      Locator
      Screening and Diagnosis, para 2 (start of screening)
      How it applies
      Start of screening in type 2 and type 1 diabetes.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7
      Reuse basis
      PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.

    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 · Diabetes Care · 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. · Published 2022-12-01 · DOI: 10.2337/dci22-0027 · PMID: 36189689 · PMCID: PMC9870667

      Locator
      Figure 1 caption
      How it applies
      Screening includes both urine albumin and eGFR; persistent abnormality diagnoses CKD.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7
      Reuse basis
      PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.

    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 · Diabetes Care · 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. · Published 2022-12-01 · DOI: 10.2337/dci22-0027 · PMID: 36189689 · PMCID: PMC9870667

      Locator
      Screening and Diagnosis, para 1 (definition)
      How it applies
      CKD definition and the 3-month persistence rule.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7
      Reuse basis
      PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.

    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 · Diabetes Care · 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. · Published 2022-12-01 · DOI: 10.2337/dci22-0027 · PMID: 36189689 · PMCID: PMC9870667

      Locator
      Introduction, para 4 (level of evidence)
      How it applies
      The consensus statements carry no level of evidence.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7
      Reuse basis
      PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.

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)
Eligibility: 2 inclusion criteria; exclusion criteria not stated
Included
  • Type 1 or type 2 diabetes
  • Chronic kidney disease as the report defines it
Excluded
None stated

  • Recommendation Guidance Certainty not assessed

    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.

    Applies to Adult
    • 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.
    • Not stated in the report.
    • Not stated in the report (a joint report of a US association and an international kidney organization)
    • 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)
    Certainty method
    Not assessed
    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
    Next evidence check due
    Not scheduled
    Sources and citations (3)

    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 · Diabetes Care · 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. · Published 2022-12-01 · DOI: 10.2337/dci22-0027 · PMID: 36189689 · PMCID: PMC9870667

      Locator
      Goals of Comprehensive Care, Consensus Statement
      How it applies
      The consensus statement on a comprehensive plan.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7
      Reuse basis
      PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.

    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 · Diabetes Care · 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. · Published 2022-12-01 · DOI: 10.2337/dci22-0027 · PMID: 36189689 · PMCID: PMC9870667

      Locator
      Goals of Comprehensive Care, para 4 (therapeutic inertia)
      How it applies
      Several treatments, added in turn; avoid therapeutic inertia.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7
      Reuse basis
      PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.

    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 · Diabetes Care · 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. · Published 2022-12-01 · DOI: 10.2337/dci22-0027 · PMID: 36189689 · PMCID: PMC9870667

      Locator
      Introduction, para 4 (level of evidence)
      How it applies
      The consensus statements carry no level of evidence.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7
      Reuse basis
      PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.

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)
Eligibility: 3 inclusion criteria; exclusion criteria not stated
Included
  • Type 2 diabetes
  • Chronic kidney disease
  • eGFR of 30 mL/min/1.73 m2 or higher
Excluded
None stated

  • Recommendation Guidance Certainty not assessed

    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.

    Applies to Adult
    • 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.
    • Not stated in the report.
    • Not stated in the report (a joint report of a US association and an international kidney organization)
    • 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)
    Certainty method
    Not assessed
    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
    Next evidence check due
    Not scheduled
    Sources and citations (2)

    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 · Diabetes Care · 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. · Published 2022-12-01 · DOI: 10.2337/dci22-0027 · PMID: 36189689 · PMCID: PMC9870667

      Locator
      ADA/KDIGO Consensus Statements, item 4 (metformin)
      How it applies
      The consensus statement on metformin and its dose limits.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7
      Reuse basis
      PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.

    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 · Diabetes Care · 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. · Published 2022-12-01 · DOI: 10.2337/dci22-0027 · PMID: 36189689 · PMCID: PMC9870667

      Locator
      Introduction, para 4 (level of evidence)
      How it applies
      The consensus statements carry no level of evidence.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7
      Reuse basis
      PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.

Record details

Record id
cardio:guideline-ada-kdigo-2022-consensus
Content hash
2916149d73062a251df7be571030881ec9041a9bcd302a578f26f0ca7e0f5548