KDIGO Launches Focused Update to 2024 CKD Guideline on Emerging Therapies

Kidney Disease: Improving Global Outcomes (KDIGO) has announced a formal update to the 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (CKD), one of the most widely used global resources for CKD evaluation and management.

The update will focus on Chapter 3, “Delaying CKD progression and managing its complications,” with particular emphasis on medical management using newer therapies in light of the evolving therapeutic landscape.

At the time the 2024 guideline was published, recommendations for therapies such as ACE inhibitors, ARBs, SGLT2 inhibitors, GLP-1 receptor agonists, and nonsteroidal MRAs were based on the best available evidence, primarily in patients with diabetes or significant albuminuria, where most trial data were available. The guidance used a cautious, stepwise approach to balance potential benefits with safety considerations, including hyperkalemia and changes in kidney function.

Since then, emerging trial data have demonstrated broader kidney and cardiovascular benefits of these therapies, including in people without diabetes, prompting KDIGO to initiate a focused update to ensure recommendations reflect the most current evidence.

“Since the publication of the 2024 KDIGO CKD Guideline, new data continue to emerge that have important implications for how we slow CKD progression and manage complications,” said Adeera Levin, MD, co-chair of the 2024 guidelines. “This focused update will ensure that KDIGO recommendations reflect the latest evidence and continue to support healthcare professionals caring for people living with CKD.”

These data include several therapies, which have been changing CKD management, including sodium-glucose cotransporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 (GLP-1)-based therapies, and nonsteroidal mineralocorticoid receptor antagonists (nsMRAs) in people with CKD without diabetes.

The update will follow the rigorous KDIGO guideline development methodology, including systematic evidence review and multidisciplinary expert input. Updated systematic evidence reviews will inform the decision to update existing recommendations and practice points. Levin is on board for the new update process, along with the original co-chair, Paul Stevens, MB, and a majority of the 2024 CKD Guideline Work Group, in order to ensure continuity and expertise.

“New cardiovascular and kidney outcomes trial data for SGLT2 inhibitors, GLP-1-based therapies, and nonsteroidal MRAs are raising important questions about how these therapies should be used in people with CKD who do not have diabetes,” said Stevens. “Our goal is to carefully review this evolving evidence and provide clear, practical guidance for healthcare professionals around the world.”

References

1. Kidney Disease: Defining Global Outcomes (KDIGO). CKD Evaluation and Management – KDIGO. KDIGO. Published 2024. Accessed March 17, 2026. https://kdigo.org/guidelines/ckd-evaluation-and-management/

2. Babitt JL, Berns JS, Bozkurt B, et al. Executive Summary of the KDIGO 2026 Clinical Practice Guideline for the Management of Anemia in Chronic Kidney Disease (CKD). Kidney International. 2026;109(1):44-56. doi:https://doi.org/10.1016/j.kint.2025.06.005