Table 5 Recommendations for people with type 2 diabetes and CKD stages 4 and 5 (non-dialysis)

1. We recommend regular monitoring of blood pressure, urine albumin, blood electrolytes and kidney function in people with diabetes and CKD stages 4 and 5 (Grade 1B).

2. We suggest, if blood pressure is uncontrolled, electrolytes are abnormal, or kidney disease is progressive they should be monitored 2 to 4 times a year depending on the stage of CKD and the individual’s need (Grade 1B).

3. We recommend initiation of antihypertensive agents in people with diabetes and CKD stages 4 and 5, and UACR < 3 mg/mmol (< 26.55 mg/g) when blood pressure is ≥140/90 mmHg and aim for a target blood pressure of < 140/90 mmHg during therapy (Grade 1B).

4. We suggest initiation of antihypertensive agents in people with diabetes and CKD stages 4 and 5 and UACR > 3 mg/mmol (> 26.55 mg/g) when blood pressure is ≥130/80 mmHg and aim for a target blood pressure < 130/80 mmHg (Grade 2C).

5. We recommend the use of angiotensin converting enzyme inhibitor (ACEI) (or angiotensin receptor blocker (ARB) if ACEI is not tolerated) as the first-choice blood pressure lowering agent in people with diabetes and CKD stages 4 and 5 and micro/macroalbuminuria (Grade 1B).

6. We do not recommend the use of combinations of ACEIs and ARBs in people with diabetes and CKD stages 4 and 5 (Grade 2B).

7. We suggest dietary advice, correction of acidosis and loop diuretic therapy to lower serum potassium as necessary in people with diabetes and CKD stages 4 and 5 for safe use of ACEI (or ARB) (not graded).

8. Consider the use of novel potassium binders in people with diabetes and CKD stages 3b to 5 (non-dialysis) if potassium is 6 mmol/L or higher, for continued and safe use of ACEi (or ARB), or where people are not taking or are only taking sub maximal RAAS blockade because of hyperkalaemia (not graded).

9. We recommend dietary input to follow low sodium diet in all individuals with diabetes, advanced chronic kidney disease and high blood pressure (Grade 1B).