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Metformin should be avoided and glipizide isthe preferred oral agentbecause it is not downgraded to a metabolite excreted by the kidneys. 6. Summary CKD will remain a health concern into the future. CKD clinics managing patients in a coordinated fashion with nutritionists and surgeons will improve lives. Better blood pressure control with diminution of proteinuria will slow the progress of established disease. Attention to acidemia and hyperruricemia will also be beneficial. New insights into the pathogenesis and treatment of diabetes may help manage the number one cause of kidney failure in America.