🫘 Diabetic Kidney Disease (DKD) Comprehensive Management
This tool frames multi-pillar management of diabetic kidney disease by eGFR and albuminuria, spanning RAAS inhibition, SGLT2 inhibitors, finerenone, glucose-lowering, and blood pressure, per KDIGO 2022.
Diabetic Kidney Disease (DKD) Comprehensive Management
eGFR (mL/min/1.73m²)
Albuminuria (UACR ≥ 30 mg/g)
When to use
Use to assemble the DKD regimen: RAAS blockade for albuminuria/hypertension, an SGLT2i at eGFR ≥ 20, finerenone for residual albuminuria, and statin/BP/lifestyle for all patients.
How it works
Pillars by eGFR/albuminuria: ACEi/ARB (albuminuria), SGLT2i (eGFR ≥ 20), finerenone (eGFR ≥ 25 + UACR ≥ 30 + normal K on RASi ± SGLT2i), metformin (eGFR ≥ 30) → GLP-1 RA, statin + BP < 130/80 for all.
Key points
- An SGLT2i is added for cardiorenal protection independent of glycemia, and a transient eGFR dip after starting is expected, not a reason to stop. (original synthesis · not guideline verbatim)
- Finerenone is added for residual albuminuria/risk on maximal RASi ± SGLT2i when potassium is normal, with potassium monitoring.
- Every DKD patient receives a statin, BP target < 130/80, and lifestyle measures, with periodic eGFR/UACR/potassium monitoring.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.