Saudi Clinical Practice Guidelines for management of diabetic kidney disease in adults

OBJECTIVES: To develop evidence-based national guidelines incorporating recent advancements in clinical research and therapeutic strategies for the management of patients with diabetic kidney disease (DKD) in the Kingdom of Saudi Arabia (KSA). METHODS: We developed the guidelines using the GRADE methodology and a multidisciplinary expert panel comprising nephrologists, endocrinologists, clinical pharmacists, and methodologists across KSA. We conducted a systematic literature review of studies published between 2014-2024. The evidence certainty was evaluated across 5 domains using GRADEpro and categorized into 4 levels: "high", "moderate", "low", and "very low". Recommendations were formulated based on the benefit-risk ratio, evidence quality, and expert consensus, with a minimum agreement threshold of 70%. RESULTS: We established 39 evidence-based recommendations addressing key aspects of DKD management, including monitoring and treatment. Among the 39 recommendations, 6 focus on lifestyle interventions, 7 address glucose-lowering therapies, one discusses glycemic monitoring and targets, 8 address DKD evaluation and risk assessment, 7 emphasize comprehensive management approaches, and 10 discuss DKD pharmacological management. Two recommendations related to the comprehensive management of DKD were based on expert opinions owing to a lack of supporting evidence. CONCLUSION: These Saudi national guidelines offer an evidence-based approach for managing DKD in adults with DM and provide a comprehensive framework for monitoring and treatment. Nevertheless, further local research and data collection are warranted to refine and enhance the guidelines' effectiveness.