KDIGO 2026 Clinical Practice Guideline for Diabetes and Chronic Kidney Disease - Chapter Updates - Public Review Draft - March 2026

Sep 18, 2026

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KDIGO 2026 Clinical Practice Guideline for Diabetes and Chronic Kidney Disease provides an updated, public review draft focused on diabetes and CKD care. The draft covers Chapter 1 (definitions, prevention, case-finding, staging, and cardiovascular risk assessment), Chapter 2 (glycemic monitoring and targets), and Chapter 4 (pharmacotherapy). It includes methods for guideline development, references, tables, and figures summarizing evidence, risk categories, screening algorithms, and key therapeutic trial outcomes to support recommendation statements and practice points.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages183

Reading Time7 h 41 min

AccessFree to download

Summary of recommendation statements and practice points

Chapter 1. Definitions, prevention, case-finding, staging, and cardiovascular risk assessment

Chapter 2. Glycemic monitoring and targets in people with diabetes and CKD

Chapter 4. Pharmacotherapy in people with diabetes and CKD

Methods for guideline development

References

KDIGO 2026 CLINICAL PRACTICE GUIDELINE FOR DIABETES AND CHRONIC KIDNEY DISEASE (CKD) CHAPTER 1, CHAPTER 2, & CHAPTER 4 UPDATE PUBLIC REVIEW DRAFT MARCH 2026 This is a draft document shared for public review and feedback only. The content of this draft will change based on the feedback received and should not be used for any other purpose beyond its original intent. TABLE OF CONTENTS Tables, figures, and supplementary materials………………………………………………………………….. ii Abbreviations and acronyms………………………………………………………….……………................... vi Notice…………………………………………………………………………………..……………………..... viii Work Group membership ………………..……………………………………….....………………………..... x Abstract……………………………………….……………………………………..…………………...…….. xi Summary of recommendation statements and practice points.....……………………………………………… 1 Chapter 1. Definitions, prevention, case-finding, staging, and cardiovascular risk assessment..…….………... 16 Chapter 2. Glycemic monitoring and targets in people with diabetes and CKD……………………………… 32 Chapter 4. Pharmacotherapy in people with diabetes and CKD……………………………………………….. 45 Methods for guideline development…………...………………………………....………………….………..... 112 References……………………………………………………………………………………………................ 126 TABLES Table 1. ADA/KDIGO consensus statements on the prevention of CKD in people with diabetes without clinical evidence of CKD 19 Table 2. Effects of relevant interventions on prevention of CKD among people with T1D or T2D without prevalent clinical manifestations of CKD 21 Table 3. Reasons to consider concomitant causes for CKD in people with diabetes requiring additional actions 28 Table 4. Potential glycemic targets for people with diabetes and CKD who use CGM 39 Table 5. Principles of comprehensive care for people with diabetes and CKD 46 Table 6. Clinical questions and systematic review topics in PICOS format 115 Table 7. Classification for certainty of the evidence 123 Table 8. GRADE system for grading the certainty of evidence 123 Table 9. KDIGO nomenclature and description for grading of recommendations 124 Table 10. Determinants of the strength of recommendation 125 FIGURES Figure 1. KDIGO heatmap with risk categories for cardiovascular disease, progression of CKD, and mortality with proposed action plans and advised annual frequency for screening 17 Figure 2. Interventions to prevent CKD and preserve kidney health among people with diabetes 19 Figure 3. Conceptual model of a paradigm shift from CKD diagnosis and treatment to primary prevention of CKD in diabetes, leading to sustained kidney health over the lifespan 20 Figure 4. A summary of CKD testing, diagnosis, and action for people with diabetes 26 Figure 5. Screening algorithm and staging for CKD using UACR and eGFR with risk assessment and management to prevent and treat people with CKD and diabetes 27 Figure 6. Evaluation of cause of CKD 28 Figure 7. Effects of CKD–related factors on HbA1c 34 Figure 8. Frequency of HbA1c measurement and use of GMI in CKD 35 Figure 9. Glossary of glucose-monitoring terms 37 Figure 19. Comprehensive strategy to reduce risk of kidney disease progression and cardiovascular disease 45 Figure 20. Holistic approach for improving outcomes in people with diabetes and chronic kidney disease 48 Figure 21. Different formulations ofACEi and ARBs 56 Figure 22 . Monitoring of serum creatinine and potassium during ACEi or ARB treatment—dose adjustment and monitoring of side effects 58 Figure 23. Cardiovascular and kidney outcome trials for SGLT2i 64 Figure 24. Pooled effect estimates of a. all-cause mortality, b. cardiovascular events, c. hospitalizations for heart failure, and d. kidney composite outcome* comparing a SGLT2i-based therapy with placebo among adults with T2D and CKD 67 Figure 25. Dosing and eGFR thresholds for SGLT2i evaluated in large clinical outcomes trials 75 Figure 26. Cardiovascular and kidney outcome trials for finerenon

FAQs

What chapters are updated in this KDIGO 2026 guideline draft?

Chapter 1, Chapter 2, and Chapter 4 are updated, covering definitions and prevention, glycemic monitoring and targets, and pharmacotherapy for diabetes with CKD.

What topics does Chapter 1 address in this draft?

Chapter 1 covers definitions, prevention, case-finding, staging, and cardiovascular risk assessment in people with diabetes and CKD.

What does the document include besides the main chapters?

It includes tables, figures, supplementary materials, and a section on methods for guideline development, along with references and front-matter sections such as abbreviations and work group membership.

Sep 18, 2026

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