Kidney Week Early 2025 Program - Diabetes Management for the Nephrology Care Team: New Technology and New Drugs-Use of Glucose-Lowering Therapies in CKD

Video Transcription

Video Summary

The session introduces an afternoon focus on diabetes therapy in chronic kidney disease (CKD), led by Josh Neumiller, a Washington State University pharmacy professor and ADA leader. Neumiller frames ADA 2025 “pillars of care” as lifestyle/education plus glycemic control, blood pressure, and lipids, with increasing emphasis on medications that provide cardiovascular (CV) and kidney protection independent of A1C needs.<br /><br />He reviews the ADA/KDIGO-aligned CKD algorithm: for type 2 diabetes with CKD, first-line drug therapy includes an SGLT2 inhibitor when eGFR ≥20 (continue until dialysis/transplant) and metformin when eGFR ≥30, with dose reduction as eGFR falls and monitoring for B12 deficiency. Kidney outcome trials (CREDENCE, DAPA-CKD, EMPA-KIDNEY) support SGLT2 benefits even at lower eGFR and in some non-diabetes CKD populations; practical guidance includes education on genital infections, volume depletion, and “sick day”/perioperative holds to reduce euglycemic DKA risk.<br /><br />GLP-1 receptor agonists are highlighted for CV benefit and emerging kidney benefit, especially semaglutide after the FLOW kidney outcomes trial; they retain glycemic efficacy in CKD and generally need no renal dose adjustment, but require slow titration for GI tolerance. Other options (insulin, DPP-4 inhibitors, sulfonylureas, pioglitazone) are briefly reviewed with CKD-specific cautions, especially hypoglycemia risk.<br /><br />In Q&A, Neumiller argues metformin remains valuable and explains DPP-4 inhibitors add little when combined with GLP-1 therapy.

Asset Subtitle

Joshua Neumiller

Meta Tag

Module DKD

Speaker Joshua Neumiller

Keywords

type 2 diabetes

chronic kidney disease (CKD)

SGLT2 inhibitors

metformin dosing by eGFR

GLP-1 receptor agonists (semaglutide)

kidney outcome trials (CREDENCE DAPA-CKD EMPA-KIDNEY FLOW)

ADA KDIGO CKD treatment algorithm