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

Worldwide, chronic kidney disease (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 (KDIGO) 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 pharmacological 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 healthcare systems and policies. In this narrative review, the authors comprising of experts in the management of CKD in T2D in Asia, convened via 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) 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.