KDIGO published guidelines on managing blood pressure in chronic kidney disease in 2020 and diabetes in chronic kidney disease in 2022. This summit, held in Kuala Lumpur in 2024, asked why they are not being delivered in the Asia-Pacific region and what would change that. It brought together the co-chairs of both guidelines with nephrologists, endocrinologists, primary care physicians, dietitians, a health economist and patient partners from 13 countries and regions, and deliberately framed solutions by income level rather than proposing one standard.
Four themes structure the report: lifestyle intervention; adopting a comprehensive team-based integrated care model; achieving treatment targets, with albuminuria screening and monitoring of kidney disease; and implementing guideline-directed medical therapies.
Albuminuria screening is where most of the practical gain sits. The guidelines assume it is being done; in much of the region it is not, and a patient whose albuminuria is never measured cannot be started on an SGLT2 inhibitor for the indication that would most benefit them. The other three themes are about the system rather than the consultation — team-based care, access to therapies, the economics of who pays — but the screening gap is one an individual clinic can close.
This is a conference report presenting a strategic framework rather than evidence of what works. It is included here because it is the rare document written about implementation in our region rather than translated from another one.
- Audit how often urine albumin-to-creatinine ratio is actually measured in your diabetes and CKD clinics
- Make albuminuria a standing item at review, not a test ordered when something looks wrong
- Identify which guideline-directed therapies your patients cannot obtain, and record the reason
- Build the dietitian and pharmacist into the clinic rather than referring outward
Why it matters
A patient whose albuminuria is never measured cannot be offered the therapy that would help them most.
Don't overread it
A summit report proposing a framework — it does not test whether any of these implementation strategies works.
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