Canadian Society of Nephrology Commentary on the 2025 Kidney Disease Improving Global Outcomes Clinical Practice Guidelines for Autosomal Dominant Polycystic Kidney Disease.

Purpose of review: 1) Provide a Canadian perspective on the 2025 Kidney Disease Improving Global Outcomes (KDIGO) Autosomal Dominant Polycystic Kidney Disease (ADPKD) guidelines; 2) identify challenges and nuances in applying these guidelines in Canada; 3) highlight shifts in expert practice points for Canadian care providers; 4) outline opportunities for research, knowledge translation, and quality improvement in Canada. Sources of information: The KDIGO 2025 Clinical Practice Guideline Update for the management of ADPKD, as well as a survey and discussion by Canadian experts in ADPKD. Methods: The co-chairs invited stakeholders from the Canadian ADPKD community to ensure national representation, including adult and pediatric clinicians, trainees, a genetic counselor, and a patient partner with an Indigenous perspective. Members were surveyed to identify key practice points. Subgroups reviewed issues and drafted discussion topics. All members reviewed the final draft. Key Findings: The committee commented on recommendations with nuance for Canadian practitioners, especially on multidisciplinary care, challenges with genetic testing, and the use of CKD therapies like sodium-glucose transport protein 2 (SGLT2) inhibitors in ADPKD. Limitations: The committee relied on the evidence summaries produced by KDIGO and the experience and knowledge of committee members. The committee did not replicate or update the systematic reviews.