Table 1:

Summary of guidelines for slowing kidney function decline in patients with CKD.

Guidelines	BP Control	RAAS Inhibition	Glycemic Control	Diet
KDIGO 2012	Goal BP: ≤140/90 mm Hg (if UACR <30 mg/g) or ≤130/80 mm Hg (if UACR ≥30 mg/g)	Start ACEI or ARB if diabetes and UACR 30–300 mg/g; start ACEI or ARB if UACR ≥300 mg/g	Goal HbA1c ~7.0%a; avoid HbA1c <7.0% if at risk of hypoglycemia; allow HbA1c >7.0% if comorbidities, limited life expectancy, or at risk of hypoglycemia	Goal <2 g/d of sodium; protein intake <1.3 g/kg/d if at risk for CKD progression; protein intake 0.8 g/kg/d if GFR<30 ml/min/1.73 m2
AHA/ACC 2017	Goal BP: <130/80 mmHg	Start ACEI if HTN and eGFR <60 ml/min/1.73 m2 or UACR ≥300 mg/g; use ARB if above indications and ACEI not tolerated	n/a	Sodium reduction if HTN
ADA and EASD 2018 (for patients with type 2 diabetes)	n/a	n/a	Goal HbA1c ≤7.0% but should be individualized; consider SGLT2i if at risk for CKD progression; consider GLP-1RA if SGLT2i not tolerated or contraindicated	n/a
ERBP 2015 (for patients with CKD G3b+)	Goal SBP: <140 mmHg	Start ACEI if diabetes and cardiovascular indication	Goal HbA1c ≤8.5% if comorbidities, limited life expectancy, or at risk of hypoglycemia; goal HbA1c ≤7.0–8.0% otherwise	n/a

None of the guidelines included recommendations relating to uric acid.

^aThe 2020 KDIGO Diabetes in CKD guideline recommends an individualized HbA1c target of <6.5% to <8.0%.

Abbreviations: AHA, American Heart Association; ACC, American College of Cardiology; BP=blood pressure; SBP=systolic blood pressure; ACEI=angiotensin-converting-enzyme inhibitor; ARB=angiotensin-receptor blocker; eGFR=estimated glomerular filtration rate; UACR=urinary albumin-creatinine ratio; HbA1c=hemoglobin A1c; SGLT2i =sodium/glucose cotransporter 2 inhibitor; GLP-1RA =glucagon-like peptide 1 receptor agonist; NA=not available; KDIGO=Kidney Disease: Improving Global Outcomes; ADA=American Diabetes Association; EASD=European Association for the Study of Diabetes; ERBP=European Renal Best Practice; HTN, hypertension

Based on KDIGO CKD Work Group 2013 (Kidney Int Suppl, https://doi.org/10.1038/kisup.2012.77); KDIGO Diabetes Work Group 2020(Kidney Int, https://doi.org/10.1016/j.kint.2020.06.019); Whelton et al 2018 (Hypertension, https://doi.org/10.1161/hyp.0000000000000065); Davies et al 2018 (Diabetologia, https://doi.org/10.1007/s00125-018-4729-5); Bilo et al 2015 (Nephrol Dial Transplant, https://doi.org/10.1093/ndt/gfv100).