Section 11. Chronic Kidney Disease and Risk Management
(https://doi.org/10.2337/dc23-S011)
The recommendation order was rearranged to reflect the appropriate order for clinical interventions aimed at preventing and slowing progression of chronic kidney disease.
In Recommendation 11.5a, the levels at which a sodium–glucose cotransporter 2 inhibitor could be initiated were changed. The new levels for initiation are an estimated glomerular filtration rate ≥20 mL/min/1.73 m2 and urinary albumin ≥200 mg/g creatinine.
Recommendation 11.5b also recommends that sodium–glucose cotransporter 2 inhibitor might also be effective in people with urinary albumin of normal to ≥200 mg/g creatinine, but this is B level at this time, as the study reporting this has not been published.
Mineralocorticoid receptor antagonists are now recommended along with other medications for cardiovascular and kidney protection rather than as alternatives when other treatments have not been effective.
Recommendation 11.8 addressing referral to a nephrologist was expanded to include referrals for continuously increasing urine albumin-to-creatinine ratio and/or for continuously decreasing estimated glomerular filtration rate.