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

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).

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%.

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.

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.