Rationale of the Week | New Standards for Kidney Disease

We quizzed test takers on the new ADA Standards of Care for Kidney Disease. 56% of respondents chose the best answer. We want to share this important info so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question

Question: Based on the 2022 ADA Standards of Care, which of the following is the most accurate statement regarding chronic kidney disease and risk management?

Answer Choices:

  • Monitor kidney function twice yearly if urinary albumin is 300 or greater and/or if GFR is 30-60.
  • For people with GFR less than 60, relax glucose target to prevent hypoglycemia.
  • If GFR is less than 30 in an individual with diabetes, avoid use of SGLT-2 Inhibitors.
  • For individuals with GFR less than 60, refer to RD to encourage low protein diet.

As shown above, the most common choice was option 1, the second most common answer was option 3, then option 2, and then finally option 4.

Getting to the Best Answer

Answer 1 is correct. 55.61% chose this answer, “Monitor kidney function twice yearly if urinary albumin is 300 or greater and/or if GFR is 30-60.” YES, GREAT JOB. Most of you chose the best answer for this new recommendation. Catching renal failure early can be life saving. Two big indicators of serious renal issues include proteinuria and a diminished GFR. Early interventions (including getting BG and BP to goal) and regular monitoring can protect kidneys for the long run.

Answer 2 is incorrect. 8.51% of you chose this answer, “If GFR is less than 30 in an individual with diabetes, avoid use of SGLT-2 Inhibitors.” This is a juicy answer. The GFR cut-offs for the SGLT-2s have been changing a lot over the past year. More research is showing that, in some cases, even with a GFR less than 30 (especially in the presence of proteinuria) SGLT-2s are indicated since they have a renal protective effect. See ADA Standard 11 on Chronic Kidney Disease for more info.

Answer 3 is incorrect. 28.05% of respondents chose this answer, “People with type 2 are less likely to experience diabetes complications than those with type 1 diabetes.” According the the National Kidney Foundation, “About 30 percent of people with Type 1 diabetes and 10 to 40 percent of those with Type 2 diabetes eventually experience kidney failure.” The most important message is to encourage people with diabetes to be actively involved in their treatment plan and advocate for best medical care to protect renal function.

Finally, Answer 4 is incorrect. 7.83% chose this answer, “For individuals with GFR less than 60, refer to RD to encourage low protein diet.” This is an outdated recommendation for over the past five years. The ADA recognized that the science does not support low protein diets as a protective intervention for those with renal disease. For people with nondialysis-dependent stage 3 or higher chronic kidney disease, dietary protein intake recommendation is 0.8 g/kg body weight per day.

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this important learning activity!



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