Implementation of Established Global Guidelines in the Management of CKD in Patients with Type 2 Diabetes in Asia

Worldwide, CKD is seen in one in nine adults; type 2 diabetes (T2D) is the most common cause. The population of just two countries in Asia, India and China, constitutes about 35% of the global population and is larger than the population of Africa or the combined populations of Europe and the Americas. CKD Global Outcomes (Kidney Disease Improving Global Outcomes) Clinical Practice Guideline for the Evaluation and Management of CKD recommends the use of foundational therapies such as lifestyle modifications, detection and treatment of hypertension, and pharmacologic management to forestall cardiovascular and kidney complications of T2D, including renin-angiotensin system inhibitors, sodium-glucose cotransporter 2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists such as finerenone, and glucagon-like peptide 1 receptor agonists. However, the implementation of these guidelines may be limited by real-world considerations, especially in Asia. This continent represents low-, middle-, and high-income countries and a variety of health care systems and policies. In this narrative review, the authors comprising of experts in the management of CKD in T2D in Asia, convened through video conferencing and online survey to discuss the perceived barriers to the implementation of guidelines with a focus on implementing the use of finerenone in CKD in T2D, particularly on the following: ( 1 ) the management of hypertension as an important comorbidity of T2D leading to CKD; ( 2 ) perceived barriers to screening for CKD in T2D; and ( 3 ) the use of finerenone in T2D with CKD, including its effects on Asian patients and perceived barriers to implementing the use of finerenone in the region.

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Publication Details

Journal
Clinical Journal of the American Society of Nephrology
Published
2025-09-23
DOI
https://doi.org/10.2215/cjn.0000000909
Citations
2
Primary Topic
Blood Pressure and Hypertension Studies
Type
article
Field-Weighted Citation Impact
2.78
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article

Implementation of Established Global Guidelines in the Management of CKD in Patients with Type 2 Diabetes in Asia

Sung Hee Choi, Bancha Satirapoj, Dibya Singh Shah, Apiradee Sriwijitkamol et al.
2 citations
Clinical Journal of the American Society of Nephrology
Blood Pressure and Hypertension Studies
2.78
article

Implementation of Established Global Guidelines in the Management of CKD in Patients with Type 2 Diabetes in Asia

Sung Hee Choi, Bancha Satirapoj, Dibya Singh Shah, Apiradee Sriwijitkamol, Carol A. Pollock, Uday Jadhav, Sung Gyun Kim, Chun‐Yao Huang, Masaomi Nangaku, Soo Kun Lim, Sunita Bavanandan, Chuan‐Ming Hao, Angela Yee‐Moon Wang, Rajiv Agarwal, Motoko Yanagita, Boon Wee Teo, Liming Chen, Sydney C.W. Tang, Mai-Szu Wu, Chien‐Ning Huang, Narayan Prasad, Elizabeth Angelica Roasa
article en
2 citations

Abstract

Worldwide, CKD is seen in one in nine adults; type 2 diabetes (T2D) is the most common cause. The population of just two countries in Asia, India and China, constitutes about 35% of the global population and is larger than the population of Africa or the combined populations of Europe and the Americas. CKD Global Outcomes (Kidney Disease Improving Global Outcomes) Clinical Practice Guideline for the Evaluation and Management of CKD recommends the use of foundational therapies such as lifestyle modifications, detection and treatment of hypertension, and pharmacologic management to forestall cardiovascular and kidney complications of T2D, including renin-angiotensin system inhibitors, sodium-glucose cotransporter 2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists such as finerenone, and glucagon-like peptide 1 receptor agonists. However, the implementation of these guidelines may be limited by real-world considerations, especially in Asia. This continent represents low-, middle-, and high-income countries and a variety of health care systems and policies. In this narrative review, the authors comprising of experts in the management of CKD in T2D in Asia, convened through video conferencing and online survey to discuss the perceived barriers to the implementation of guidelines with a focus on implementing the use of finerenone in CKD in T2D, particularly on the following: ( 1 ) the management of hypertension as an important comorbidity of T2D leading to CKD; ( 2 ) perceived barriers to screening for CKD in T2D; and ( 3 ) the use of finerenone in T2D with CKD, including its effects on Asian patients and perceived barriers to implementing the use of finerenone in the region.

Clinical Journal of the American Society of Nephrology
The University of Sydney (AU), University Malaya Medical Centre (MY), Siriraj Hospital (TH), Sanjay Gandhi Post Graduate Institute of Medical Sciences (IN), National University of Singapore (SG), Kyoto University (JP), Singapore General Hospital (SG), Fudan University (CN), Hospital Kuala Lumpur (MY), Queen Mary Hospital (CN), Taipei Medical University Hospital (TW), Seoul National University Bundang Hospital (KR), University of Malaya (MY), Phramongkutklao Hospital (TH), Chung Shan Medical University Hospital (TW), Grande International Hospital (NP), Duke-NUS Medical School (SG), National University Hospital (SG), Hallym University Sacred Heart Hospital (KR), Indiana University School of Medicine, Indiana University – Purdue University Indianapolis (US), Tianjin Medical University (CN), The University of Tokyo (JP), University of Santo Tomas (PH), University of Hong Kong (HK)
Openalex Percentile: Top 8%
Blood Pressure and Hypertension Studies
2.78
DOISourceOpenAlex
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