From the Guidelines
Chronic Kidney Disease (CKD) is best managed by understanding its five stages based on glomerular filtration rate (GFR) and implementing stage-specific management to improve morbidity, mortality, and quality of life. The stages of CKD are defined as follows:
- Stage 1: GFR ≥90 mL/min with kidney damage
- Stage 2: GFR 60-89 mL/min
- Stage 3: GFR 30-59 mL/min, further divided into 3a (GFR 45-59 mL/min) and 3b (GFR 30-44 mL/min)
- Stage 4: GFR 15-29 mL/min
- Stage 5: GFR <15 mL/min or kidney failure requiring dialysis or transplantation 1.
Management of CKD
Management of CKD involves:
- Blood pressure control with ACE inhibitors or ARBs to reduce proteinuria and slow progression
- Glycemic control in diabetic patients aiming for HbA1c around 7%
- Dietary modifications including sodium restriction, potassium limitation, and protein moderation
- Treatment of complications such as anemia, bone disorders, and cardiovascular risk reduction
- Regular monitoring of kidney function, electrolytes, and complications, with increasing frequency as CKD advances 1.
Key Considerations
- Early detection and management of CKD are crucial to prevent progression and improve outcomes.
- Referral to a nephrologist is recommended for patients with GFR <30 mL/min/1.73 m2 or those who require specialized care 1.
- A comprehensive approach addressing the underlying pathophysiology and emerging complications is essential to preserve kidney function and improve quality of life 1.
From the Research
CKD Stages
- Chronic Kidney Disease (CKD) is defined as decreased kidney function shown by glomerular filtration rate (GFR) of less than 60 mL/min per 1·73 m2, or markers of kidney damage, or both, of at least 3 months duration, regardless of the underlying cause 2
- The stages of CKD are classified based on the GFR, with stage 1 being the least severe and stage 5 being the most severe
- The management of CKD involves lifestyle modifications, medications, and in some cases, dialysis or kidney transplantation
Management of CKD
- Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) are commonly used in patients with early CKD to reduce blood pressure and proteinuria 3
- However, the value of ACEi/ARB in advanced CKD (estimated GFR (eGFR) ≤30 ml/min/1.73 m2) is unknown, and there is a debate about the omission of ACEi/ARB in patients with advanced CKD 4
- Studies have shown that ACEi/ARB can be continued in patients with advanced CKD unless hyperkalemia ensues unresponsive to therapy, hypotension develops, or there is an unusually rapid worsening of eGFR 5
- Patients with CKD should be monitored closely for changes in renal function, worsening heart failure, and hyperkalemia, especially when taking ACEi/ARB 6
Monitoring and Follow-up
- Regular monitoring of GFR, blood pressure, and proteinuria is essential in patients with CKD
- Patients with CKD should be followed up regularly to assess the progression of the disease and to adjust treatment as needed
- Lifestyle modifications, such as a healthy diet and regular exercise, can help slow the progression of CKD and reduce the risk of cardiovascular disease 2