How to manage a patient with chronic kidney disease (CKD) and impaired renal function?

From the Guidelines

Managing a patient with chronic kidney disease (CKD) and impaired renal function, such as a creatinine level of 1.7, BUN of 51, and GFR of 36, requires a comprehensive approach focused on slowing disease progression, managing complications, and preventing cardiovascular events.

Key Management Strategies

• Optimize blood pressure control using ACE inhibitors or ARBs as first-line agents, such as lisinopril 10-40 mg daily or losartan 50-100 mg daily, as recommended by 1.
• Implement dietary modifications including sodium restriction to <2g daily, protein moderation (0.8g/kg/day for most CKD patients), and potassium and phosphorus restrictions as needed based on laboratory values, as suggested by 1.
• Glycemic control is essential for diabetic patients, targeting HbA1c around 7%, with metformin often safe until eGFR falls below 30 ml/min/1.73m², and consider SGLT2 inhibitors like empagliflozin 10-25 mg daily or dapagliflozin 5-10 mg daily for their renoprotective effects, as discussed in 1.

Complication Management

• Manage complications including anemia, mineral bone disorder, and metabolic acidosis, and adjust medication dosages based on renal function, avoiding nephrotoxic agents including NSAIDs.
• Ensure regular monitoring of renal function, electrolytes, and proteinuria every 3-6 months.

Referral and Further Care

• Timely nephrology referral is crucial, particularly when eGFR falls below 30 ml/min/1.73m², to discuss renal replacement therapy options and optimize pre-dialysis care, as emphasized by 1 and 1. By following these guidelines and considering the patient's specific needs and laboratory values, healthcare providers can develop an effective management plan for patients with CKD and impaired renal function.

From the Research

Patient Profile

• Creatinine level: 1.7
• BUN (Blood Urea Nitrogen): 51
• GFR (Glomerular Filtration Rate): 36

Management of Chronic Kidney Disease (CKD)

To manage a patient with CKD and impaired renal function, the following points should be considered:

• The patient's serum creatinine level and GFR indicate impaired renal function, which requires careful management to slow disease progression 2.
• ACE inhibitors can be effective in reducing proteinuria and slowing renal disease progression, but may cause an initial rise in serum creatinine levels 3, 4, 2.
• The use of angiotensin receptor blockers (ARBs) may be associated with lower mortality than ACE inhibitors in patients with advanced CKD 5.
• Exogenous factors, such as creatine supplements, can influence serum creatinine levels and should be considered when evaluating renal function 6.

Treatment Considerations

• ACE inhibitors or ARBs may be used to manage CKD, but require careful monitoring of renal function and serum potassium levels 3, 5, 4, 2.
• Patients with CKD should be monitored for signs of hyperkalemia, particularly when using ACE inhibitors or ARBs 2.
• Sodium restriction and diuretic use may be necessary to manage fluid balance and blood pressure in patients with CKD 4, 2.