Clinical practice guideline for the management of lipids in adults with diabetic kidney disease: abbreviated summary of the Joint Association of British Clinical Diabetologists and UK Kidney Association (ABCD-UKKA) Guideline 2024
ABCD / UKKA · 2024 · United Kingdom
Source and licence
- Authors
- Sagen Zac-Varghese, Patrick Mark, Steve Bain et al.
- Title
- Clinical practice guideline for the management of lipids in adults with diabetic kidney disease: abbreviated summary of the Joint Association of British Clinical Diabetologists and UK Kidney Association (ABCD-UKKA) Guideline 2024
- Journal
- BMC Nephrology, 2024
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC11227212
Licence statement of the original publication
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This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
Recommendations for lipid measurement and frequency of monitoring
- We recommend that a non-fasting full lipid profile (TC, non-HDL, HDL, LDL cholesterol and TG) is performed at least annually in stage G1-5 DKD, including post kidney transplantation and, where appropriate, in dialysis, stage G5d.
- LDL cholesterol is calculated (using the Friedewald formula) and requires a fasting sample if TG levels are > 4.5 mmol/L. In hypertriglyceridaemia (> 4.5 mmol/L), we recommend measuring fasting profilesGrade 1B
- We suggest review of the lipid profile on commencement or change of modality of renal replacement therapy (dialysis or kidney transplantation)Grade 2D
- Following kidney transplantation, we suggest that lipid status be assessed once the immediate post-operative period has passed (typically 3 months post transplantation)Grade 2D
Recommendations for lipid management in type 1 diabetes
- We suggest that in type 1 diabetes and stage G1–2 DKD, lipid-lowering therapy is commenced in the following categories: • People aged > 30 years with persistent albuminuria, category A2-3 (Grade 2D). • People aged between 18 to 30 years with persistent albuminuria, category A2-3, and ≥ 1 additional CVD risk factorGrade 2D
- We recommend that in type 1 diabetes and stage G3–5 DKD, regardless of albuminuric status, lipid-lowering therapy is commencedGrade 1C
- In people with type 1 diabetes on dialysis, stage G5d DKD, we do not recommend initiation of lipid lowering therapy. However, we suggest that in certain cases, e.g. in those where transplantation is a likely outcome and where dialysis is temporary, initiation might be beneficial and may be consideredGrade 2D
Recommendations for lipid management in type 2 diabetes
- We recommend that in people with type 2 diabetes with stage G1–2 DKD, lipid-lowering therapy is commenced in the following categories: • People aged > 30 years with persistent albuminuria, category A2-3 (Grade 1C). • People aged between 18 to 30 years with persistent albuminuria, category A2-3, and ≥ 1 additional CVD risk factorGrade 1D
- We recommend that lipid-lowering therapy with statins should be considered in people with stage G3–5 DKD regardless of albuminuric statusGrade 1B
- In people with type 2 diabetes on dialysis, stage G5d DKD, we do not recommend initiation of lipid lowering therapy. However, we suggest that in certain cases, e.g. in those where transplantation is a likely outcome, initiation might be beneficial and may be consideredGrade 2D
Combined kidney pancreas transplant and lipid lowering
- We suggest that lipid-lowering agents be continued in those commencing dialysis,Grade 2D
- We suggest that the decision to commence lipid-lowering agents de novo in those requiring dialysis (haemodialysis or peritoneal) should take into account risk of future atherosclerotic vascular events, life expectancy and, other comorbid diseaseGrade 2D
- Where indicated, we recommend that lipid-lowering agents should be commenced post kidney transplantation or combined kidney-pancreas transplantation and that the choice and dose of lipid-lowering agent should take into account concurrent immunosuppressive therapyGrade 1C
- Where indicated, we suggest that people who develop post-transplant diabetes mellitus are treated with lipid-lowering agentsGrade 2D
Recommendations for treatment targets
- We suggest the following treatment targets.
- LDL cholesterol ≤ 1.8 mmol/LGrade 2D
Recommendations
- At all stages of DKD, we recommend initiation with statin therapy, atorvastatin 20 mgGrade 1D
- In stage G1-G3a DKD, we recommend consideration of higher dose/intensity statin therapy for those who do not attain treatment targets on lower statin doses and recommend seeking specialist advice if eGFR < 30 ml/min/1.73 m2Grade 1D
- At all stages of DKD, we suggest consideration of submaximal statin and ezetimibe 10 mg combination therapy in those unable to tolerate higher statin dosesGrade 2B
- At all stages of DKD, in those with statin intolerance, we suggest ezetimibe 10 mg aloneGrade 2D
- In stage G1-G3a DKD, in those with statin intolerance, we suggest ezetimibe 10 mg in combination with Bempedoic acid 180 mg where treatment targets are not metGrade 2D
- In stage G1–G3a DKD, we suggest that fenofibrate therapy (alone or in combination with statins) should only be used with specialist adviceGrade 2C
- In stage G3b–5 DKD, we recommend that there is no role for fibrates outside specialist careGrade 1B
- We do not recommend fibrate ezetimibe combination therapy without specialist adviceGrade 1D
- We suggest consideration of inclisiran, in line with licensing and national guidelines, for secondary prevention in people who fail to achieve treatment targets. Currently there is limited data for use of inclisiran in severe DKD or ESKD; however, evidence exists for benefit up to stage G3b DKDGrade 2C
- We suggest consideration of PCSK9 inhibitors, in line with licensing guidelines, in people who fail to achieve treatment targets. Currently there is limited data for use in severe DKD or ESKD; however, evidence exists for benefit up to stage G3b DKDGrade 2C
- We suggest consideration of icosapent ethyl for secondary prevention, in line with licensing guidelines, in people with elevated fasted TG > 1.7 mmol/L and LDL cholesterol between 1.04 and 2.60 mmol/L. Currently there is limited data for use in severe DKD or ESKDGrade 2C
Abstract
The contribution of chronic kidney disease (CKD) towards the risk of developing cardiovascular disease (CVD) is magnified with co-existing type 1 or type 2 diabetes. Lipids are a modifiable risk factor and good lipid management offers improved outcomes for people with diabetic kidney disease (DKD).
The primary purpose of this guideline, written by the Association of British Clinical Diabetologists (ABCD) and UK Kidney Association (UKKA) working group, is to provide practical recommendations on lipid management for members of the multidisciplinary team involved in the care of adults with DKD.
Contents of the original publication
The section headings of the original.
- Introduction
- Methodology
- Recommendations for lipid measurement and frequency of monitoring
- Recommendations for lipid management in type 1 diabetes
- Recommendations for lipid management in type 2 diabetes
- Recommendations for lipid management in ESKD and dialysis
- Recommendations for lipid management post-transplantation
- Post-transplant diabetes mellitus and lipid lowering
- Combined kidney pancreas transplant and lipid lowering
- Recommendations for treatment targets
- Choice of lipid-lowering agent
- Recommendations
- Recommendations for the monitoring and safety of lipid-lowering agents
- Recommendation for when to stop lipid-lowering agents
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