KDIGO Announces new Clinical Practice Guideline for the Evaluation and Management of CKD

By Brian Murphy

According to the ACDIS 2023 CDI Week Industry Overview Survey, kidney disease was ranked the fifth highest denied diagnosis (29.7% of respondents) after sepsis, respiratory failure, malnutrition, and encephalopathy.

So it behooves you to know the latest and greatest clinical practice guidelines from the authoritative body who establishes them. Because you can be sure savvy payers will be reading them, too.

The KDIGO announced this month the latest in kidney disease management: The publication of the 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (CKD).

This is an update to the previous guideline published in 2012. Much has happened with diagnosis and treatment since then and KDIGO provides an in-depth summary and update.

Links in the comments below.

Per KDIGO the new guideline is intended for healthcare professionals who provide kidney care, for people with suspected or diagnosed CKD and their caregivers, and for policymakers and commissioners of CKD services (not directly mentioned this extends to mid-revenue cycle professionals, whose work helps with accurate diagnosis and reporting).

I’m not a clinician and lack the context to say whether this is a “wow” or a “meh” moment. But it appears to be a worthwhile event. Per Kidney International, “the majority of statements from the 2012 guideline have been updated based on current knowledge and practice. Only six statements were retained in their original form in 2012.”

KDIGO says the critical highlights include updates on the measurements of estimated glomerular filtration rate (GFR) and albuminuria, utilization of CKD risk prediction equations, and personalized treatment recommendations for kidney and cardiovascular risk reductions tailored to individual patient needs and preferences.

I also found a useful supplemental article published by HCP Live that summarizes some of the key changes.

On a high level, the new KDIGO guidelines include:

• Recommendation statements and practice guidelines for CKD diagnosis and prediction

• Treatment strategies, drug stewardship and approaches to CKD management

• Management of complications (always important for CDI professionals to know)

• Refinements to glomerular filtration rate (GFR) evaluation

• Population and individual risk prediction

An Executive Summary is planned for publication in the April 2024 issue of Kidney International.

Fine weekend reading. You can also share it with your physician advisor and nephrologists and look like the smartest person in the room.

After I posted this article on LinkedIn I got a thoughtful response from a clinician, who noted, “Providers often push back on the current KDIGO guidance around serum creatinine trends that help validate a present on admission AKI vs one that develops during the inpatient stay. As the KDIGO-recommended serum creatinine calculations are more likely to be performed by a CDI specialist or auditor than a clinician, some further and updated AKI guidance is warranted, ideally one with a clinical rather than mathematical spin!”

I agree. These guidelines are welcomed. Read them in full below.

References

• KDIGO, KDIGO Announces Publication of 2024 CKD Guideline: https://kdigo.org/kdigo-announces-publication-of-2024-ckd-guideline/

• Kidney International, Executive summary of the KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease: known knowns and known unknowns: https://www.kidney-international.org/article/S0085-2538(23)00764-0/fulltext?dgcid=raven_jbs_etoc_email

• ACDIS, 2023 CDI Week Industry Overview Survey: file:///Users/Brian1/Downloads/https___acdis.org_sites_acdis_files_cdi-week_CR-7838%2520CDI%2520Week%2520Industry%2520Survey%25202023_final.pdf

• HCP Live, KDIGO Releases Updated 2024 CKD Clinical Practice Guideline: https://www.hcplive.com/view/kdigo-releases-updated-2024-ckd-clinical-practice-guideline