KDIGO published its guideline on managing diabetes in chronic kidney disease in 2022 and its blood pressure guideline in 2020. The gap between those documents and what patients actually receive was the subject of an implementation summit held in Kuala Lumpur in 2024, whose report is now out. It brought together the co-chairs of both guidelines with nephrologists, endocrinologists, primary care physicians, dietitians, a health economist and patient partners from 13 Asia-Pacific countries and regions.
The discussion ran on four themes: lifestyle intervention; adopting a team-based integrated care model; achieving treatment targets, with albuminuria screening and monitoring singled out; and implementing guideline-directed medical therapy. The output is a strategic framework of actions, and its distinguishing feature is that solutions are graded by the income level of the country or region rather than offered as one recommendation for everyone.
That framing is why this belongs at the end of an edition rather than filed as a conference report. The therapies are settled - what is not settled is albuminuria being measured at all, a dietitian existing in the clinic, or an SGLT2 inhibitor being affordable to the person who needs it. For an Indian nephrologist the actionable part is auditable: what proportion of your diabetic patients had a urine albumin-to-creatinine ratio in the last twelve months, and what proportion of those with albuminuria are on guideline-directed therapy. Both are numbers a clinic can produce this month, and both are the actual bottleneck.
- Audit albuminuria screening coverage in your own diabetic population - it is the step the summit singles out.
- Check what proportion of patients with albuminuria are actually on guideline-directed therapy, and why the rest are not.
- Build the team around the clinic where you can: dietitian, pharmacist, nurse educator - the summit puts integrated care above any single drug.
- Match the intervention to what is affordable locally; the framework is deliberately tiered by income level.
- Treat cost of therapy as a clinical variable to be documented, not an excuse recorded outside the notes.
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