Updated Guidelines Reflect Advances in CKD Management

As management of chronic kidney disease (CKD) continues to develop, there is a need for updated guidelines to encompass all intervention methods, including new therapeutic methods and those that can be managed in the primary care setting. A review published in Annals of Internal Medicine describes new guidelines from 2025 related to the diagnosis, assessment, and management of CKD.¹

How Prevalent is CKD?

According to the authors of the paper, the prevalence of CKD in US adults is approximately 14%, most of whom are not aware of their diagnosis. Although limited by a lack of published data, CKD prevalence among those in the US Department of Veterans Affairs (VA) and US Department of Defense (DoD) ranges between 1.9% and 16.4%, with a higher prevalence in the former population. Since the last VA/DoD clinical practice guideline (CPG) for the management of CKD in 2019, there has been new research supporting the expansion and new indications of therapeutic options in the management of CKD, such as the FDA approval of semaglutide (Ozempic; Novo Nordisk) for reducing kidney disease and cardiovascular death risk in adults with type 2 diabetes and CKD.^1,2

The CPG can be used by all health care professionals who help patients with CKD manage their disease, but the VA/DoD CPG is specifically intended for primary care clinician use. This is particularly relevant because most patients—especially those with early-stage CKD when interventions may have the greatest benefit—are managed primarily by primary care clinicians, who slow the progression of CKD, improve cardiovascular outcomes, and reduce the risk of mortality. As disease advances, management is often supported by nephrology specialists.¹

“CKD is associated with increased risk of cardiovascular disease, increased mortality, and poor quality of life,” first author Amy R. Schwartz, MD, of the VA Connecticut Healthcare System in West Haven, Connecticut, said in a news release. “Through earlier detection of CKD and the proactive use of treatments described in this guideline, primary care providers can slow the progression of CKD, improve cardiovascular outcomes, and reduce mortality.”³

What Do the 2025 Guidelines Recommend?

The 2025 VA/DoD CKD CPG includes 23 evidence-based recommendations, of which 21 are either new or modified from the 2019 guidelines. These reflect a plethora of new pharmacotherapeutic options, the authors wrote, with 11 recommendations specifically focused on pharmacologic management. These recommendations include the following¹:

• The use of statins in patients with CKD who are not on dialysis;
• The use of an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB) in patients with hypertension and albuminuria;
• Adding a sodium–glucose cotransporter 2 (SGLT2) inhibitor in patients with CKD and type 2 diabetes, albuminuria, or heart failure;
• Adding a glucagon-like peptide 1 (GLP-1) receptor agonist (RA) in patients with type 2 diabetes and albuminuria;
• Referral of patients with autosomal-dominant polycystic kidney disease to nephrology to consider tolvaptan.

Additionally, 4 amended recommendations address testing for CKD, estimation of the glomerular filtration rate (eGFR), and prediction of CKD progression. Additional recommendations guide the management of hypertension in CKD, avoidance of contrast-associated acute kidney injury (AKI), and decision-making about kidney replacement therapy versus conservative management.¹

“I think the most notable change to the guideline is the addition of recommendations for primary care providers to use newer pharmaceutical agents to slow down the progression of CKD, specifically SGLT2 inhibitors, GLP-1 RAs, and finerenone,” James D. Oliver, III, a nephrologist practicing in Bethesda, Maryland, said in the news release. “These medications are among the most significant advances in the treatment of CKD in several decades; however, we still have older medications such as ACE inhibitors and ARBs, which are effective but being underutilized. The guideline provides clarity for [primary care clinicians when] addressing the most significant risk factors in the progression of CKD, namely high blood pressure and urine albumin.”³

REFERENCES

1. Schwartz AR, Sosnov J, Brown J, et al. 2025 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline for the Primary Care Management of Chronic Kidney Disease. Ann Intern Med. Published online 30 December 2025. doi:10.7326/ANNALS-25-03499

2. Halpern L. FDA Approves Semaglutide to Reduce Kidney Disease, Cardiovascular Death Risk in Adults With Type 2 Diabetes, Chronic Kidney Disease. Pharmacy Times. January 28, 2025. Accessed January 12, 2026. https://www.pharmacytimes.com/view/fda-approves-semaglutide-to-reduce-kidney-disease-cardiovascular-death-risk-in-adults-with-type-2-diabetes-chronic-kidney-disease

3. Melville NA. Updated CKD Management Guideline Focuses on Pharmacotherapy. Medscape. January 12, 2026. Accessed January 12, 2026. https://www.medscape.com/viewarticle/updated-ckd-management-guideline-focuses-pharmacotherapy-2026a10000wf