This publication of the Kidney Disease Outcomes Quality Initiative™ (KDOQI™) Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease (CKD) represents the first guideline that considers the unique aspects of the evaluation, diagnosis, and management of the complex patient with both diabetes mellitus and CKD.
Given the epidemic of obesity, diabetes, and cardiovascular disease and the link to CKD, it is clear that this guideline will be of immense importance to a broad audience of practioners and patients. As for all KDOQI™ guidelines, all relevant epidemiological studies and clinical trials have been reviewed to ensure a balanced presentation of the key aspects of diabetes and CKD.
The key points have been made that the combination of CKD and diabetes is a cardiovascular disease multiplier, and that these patients are at high risk of cardiovascular disease. The unique challenges of managing patients and the need to intervene early in the course of disease are discussed within the context of specific recommendations. As in all recent KDOQI™ guidelines, the difference between clinical practice guidelines (which are based on a sound evidentiary base) and clinical practice recommendations (which have a less sound evidentiary base, and on which ongoing research is needed) have been separated.
There are some topics within this guideline that address special populations (including native populations and pregnant women). These were included to ensure that 1 document could be used by practioners to address frequently asked key questions.
This guideline has been developed by using the usual rigorous methods of the KDOQI™ process and has involved multiple disciplines from both US and international sources. These perspectives have been invaluable in ensuring a robust document with broad perspective. This final version of this document has undergone revision in response to comments during the public review process, an important and integral part of the KDOQI™ guideline process. Nonetheless, as with all guideline documents, there will be a need in the future for revision in the light of new evidence and, more importantly, a concerted effort to translate the guidelines into practice.
We hope that this first guideline for the evaluation and management of patients with diabetes and kidney disease will foster additional research and facilitate implementation of key strategies for the early identification and treatment of this growing population. Implementation is an integral component of the KDOQI™ process, and it accounts for the success of its past guidelines. The Kidney Learning System component of the National Kidney Foundation is developing implementation tools that will be essential to the success of these guidelines.
In a voluntary and multidisciplinary undertaking of this magnitude, many individuals make contributions to the final product now in your hands. It is impossible to acknowledge them individually here, but to each and every one of them, we extend our sincerest appreciation. This limitation notwithstanding, a special debt of gratitude is due to the members of the Work Group and their co-chairs, Katherine Tuttle and Robert Nelson. It is their commitment and dedication to the KDOQI™ process that has made this document possible.
Adeera Levin, MD
KDOQI Chair
Michael Rocco, MD, MSCE
KDOQI Vice-Chair