From the Guidelines
Chronic kidney disease (CKD) should be managed by controlling blood pressure, ideally maintaining levels below 130/80 mmHg, using medications like ACE inhibitors or ARBs, and tightly controlling blood glucose in diabetic patients, aiming for HbA1c around 7%, as recommended by the most recent guidelines 1.
Diagnosis of CKD
The diagnosis of CKD is based on the presence of kidney damage or decreased kidney function, as indicated by a glomerular filtration rate (GFR) below 60 mL/min/1.73 m² or the presence of albuminuria, which is defined as a urinary albumin-to-creatinine ratio (UACR) greater than 30 mg/g 1.
Management of CKD
The management of CKD focuses on slowing the progression of the disease and treating its complications. This includes:
- Controlling blood pressure using ACE inhibitors or ARBs, which provide renoprotective effects beyond blood pressure control 1
- Tightly controlling blood glucose in diabetic patients, aiming for HbA1c around 7% 1
- Dietary modifications, including sodium restriction to 2-3 grams daily, protein limitation to 0.8 g/kg/day in advanced CKD, and potassium restriction in later stages 1
- Regular monitoring of kidney function through eGFR and UACR, typically every 3-12 months depending on CKD stage 1
- Anemia management with erythropoietin-stimulating agents when hemoglobin falls below 10 g/dL, and mineral-bone disorder management with phosphate binders, vitamin D supplements, and sometimes calcimimetics 1
- Avoiding nephrotoxic medications, including NSAIDs, and adjusting medication dosages as kidney function declines 1
Referral to Nephrology
Early nephrology referral is recommended when eGFR falls below 30 ml/min/1.73m² to prepare for possible kidney replacement therapy if needed 1.
Recent Updates in Management
Recent updates in the management of CKD include the use of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists, which have been shown to reduce the risk of progression of kidney disease and cardiovascular events in patients with diabetic kidney disease 1.
From the Research
Diagnosis of Chronic Kidney Disease (CKD)
- CKD is defined as either kidney damage or an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m2 for more than 3 months 2
- Kidney damage is defined as pathological abnormalities or markers of damage, including abnormalities in blood or urine tests or imaging studies 2
- CKD is classified as stage 1 to 5 on the basis of eGFR 2
- Early recognition and intervention are essential to slowing disease progression, maintaining quality of life, and improving outcomes 3
Management of CKD
- The management of CKD is complex and requires a multidisciplinary approach 4
- Blood pressure control is essential in patients with CKD, with a target blood pressure of less than 130/80 mm Hg, or 125/75 mm Hg, if amount of urinary protein is more than 1 g/day 5, 2, 3
- Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers are recommended as first-line agents for controlling blood pressure due to their renoprotective effects 5, 2, 3
- Lifestyle modifications such as dietary changes, physical activity, and smoking cessation are also recommended 5, 4, 3
- Regular monitoring of kidney function and referral to a nephrologist for patients with advanced CKD or other complications are necessary 4, 3
Treatment of CKD Complications
- Hyperglycemia should be treated, with a goal of an AIC concentration below 7 percent 3
- Dyslipidemia should be treated with statin therapy to reduce the risk of cardiovascular disease 3
- Anemia should be treated, with a target hemoglobin concentration of 11 to 12 g per dL (110 to 120 g per L) 3
- Hyperparathyroid disease requires dietary phosphate restrictions, antacid use, and vitamin D supplementation; if medical therapy fails, referral for surgery is necessary 3
Prevention of CKD Progression
- Early detection and management of CKD can slow the progression of the disease 6, 4
- Interventions to slow the progression of CKD include blood pressure control, glycemic control in diabetic patients, and reduction of proteinuria 6, 4
- Lifestyle modifications such as dietary changes, physical activity, and smoking cessation can also help prevent CKD progression 5, 4, 3