From the Guidelines
Teaching patients with Stage 3b chronic kidney disease (CKD) should focus on slowing disease progression and managing complications, with a key emphasis on medication management, dietary modifications, and lifestyle changes to improve morbidity, mortality, and quality of life. Key teaching points include:
- Medication management, with emphasis on avoiding nephrotoxic drugs like NSAIDs and ensuring proper dosing of medications cleared by the kidneys, as people with CKD may be more susceptible to the nephrotoxic effects of medications 1
- Blood pressure control is critical, with a target below 130/80 mmHg using ACE inhibitors or ARBs when appropriate, and continuing ACEi or ARB in people with CKD even when the eGFR falls below 30 ml/min per 1.73 m2 1
- Dietary modifications are essential, including:
- Limiting sodium to 2,000 mg daily
- Moderating protein intake to 0.8 g/kg/day, and avoiding high protein intake (>1.3 g/kg body weight/d) in adults with CKD at risk of progression 1
- Restricting potassium and phosphorus if levels are elevated
- Regular monitoring of kidney function through blood tests (creatinine, eGFR, electrolytes) every 3-6 months helps track disease progression
- Patients should understand the importance of glycemic control if diabetic, with a target HbA1c of 7-8%
- Lifestyle modifications include:
- Maintaining a healthy weight
- Regular exercise (30 minutes most days) compatible with cardiovascular health, tolerance, and level of frailty 1
- Smoking cessation
- Limiting alcohol
- Patients should be educated about potential complications like anemia, bone disease, and cardiovascular issues, and the importance of vaccinations against influenza, pneumococcal disease, and hepatitis B
- Referral to providers and programs (e.g., psychologists, renal dietitians or accredited nutrition providers, pharmacists, physical and occupational therapy, and smoking cessation programs) should be offered where indicated and available 1
From the Research
Stage 3B Chronic Kidney Disease Teaching Points
- Patients with stage 3B chronic kidney disease (CKD) are at high risk of progressing towards end-stage kidney disease and have an elevated risk of cardiovascular morbidity and mortality 2.
- The management of hypertension in stage 3B CKD is crucial, as it is a major cause of poor cardiovascular and renal outcomes 2.
- Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) can be used to slow down the progression of CKD, and combination treatment may provide greater renoprotection than either treatment alone 3.
- The National Kidney Foundation suggests that ACE inhibitors and ARBs may be used in combination to reduce proteinuria in patients with kidney disease, but larger outcomes trials are needed 3.
- Identifying patients with stage 3B CKD using the estimated glomerular filtration rate (eGFR) equation can help detect the risk of renal failure, as these patients may have normal results on routine clinical assessments 4.
- Patients with stage 3B CKD have a high risk of renal failure, with a 20% risk of developing renal failure within 2 years 4.
- Medical therapy for patients with heart failure and stage 3B CKD should be evidence-based, and most drug classes are safe and effective up to CKD stage 3B (eGFR minimum 30 mL/min/1.73 m2) 5.
- Clinical practice guidelines for the management of older patients with CKD stage 3B or higher recommend a comprehensive approach to care, including management of hypertension, proteinuria, and other comorbidities 6.