From the Guidelines
The treatment for stage 3 kidney disease should focus on slowing disease progression and managing complications, with a strong recommendation for pharmacologic therapy that includes either an angiotensin-converting enzyme inhibitor or an angiotensin II-receptor blocker for patients with hypertension 1.
Key Components of Treatment
- Blood pressure control is crucial, and medications like ACE inhibitors (such as lisinopril 10-40 mg daily) or ARBs (such as losartan 50-100 mg daily) are recommended to reduce pressure within the kidneys and protect kidney function 1.
- For patients with elevated low-density lipoprotein, statin therapy is recommended to manage cholesterol levels and reduce the risk of cardiovascular complications 1.
- Dietary modifications are essential, including:
- Limiting sodium to 2,300 mg daily
- Moderating protein intake to 0.8 g/kg body weight per day
- Restricting phosphorus and potassium if levels are elevated
- Regular exercise, such as 150 minutes of moderate-intensity aerobic activity weekly, helps maintain overall health and slow disease progression.
- Patients should avoid nephrotoxic medications like NSAIDs and certain antibiotics to minimize additional kidney stress.
Monitoring and Follow-up
- Regular monitoring of kidney function every 3-6 months is necessary to track disease progression and adjust treatment as needed.
- Addressing complications may require additional medications, such as phosphate binders for high phosphorus levels or vitamin D supplements for deficiencies. By following these recommendations and guidelines, patients with stage 3 kidney disease can slow disease progression, manage complications, and improve their overall quality of life 1.
From the FDA Drug Label
Losartan is indicated for the treatment of diabetic nephropathy with an elevated serum creatinine and proteinuria (urinary albumin to creatinine ratio ≥300 mg/g) in patients with type 2 diabetes and a history of hypertension In this population, losartan reduces the rate of progression of nephropathy as measured by the occurrence of doubling of serum creatinine or end stage renal disease (need for dialysis or renal transplantation)
The treatment for stage 3 kidney disease (Chronic Kidney Disease, CKD) may include losartan to reduce the rate of progression of nephropathy, particularly in patients with type 2 diabetes and hypertension. However, it is essential to note that this is specifically for patients with diabetic nephropathy and not all stage 3 kidney disease patients.
- The primary goal is to slow the progression of kidney disease by managing blood pressure and proteinuria.
- Losartan may be used as part of a comprehensive treatment plan, which may include other medications and lifestyle modifications 2.
From the Research
Treatment for Stage 3 Kidney Disease
The treatment for stage 3 kidney disease, also known as Chronic Kidney Disease (CKD), involves a combination of lifestyle modifications, nutritional interventions, and medical therapies. The primary goal of treatment is to slow the progression of the disease and prevent complications.
Lifestyle Modifications
- Walking, weight loss, and low-protein diet (LPD) can slow the progression of CKD 3
- Adherence to the alternate Mediterranean (aMed) diet and Alternative Healthy Eating Index (AHEI)-2010 can also slow the progression of CKD 3
- Smoking and binge alcohol drinking should be avoided as they increase the risk of CKD progression 3
- Regular physical activity, such as supervised exercise training, can improve cardiorespiratory fitness and exercise capacity in patients with CKD 4
Medical Therapies
- Blood pressure control is crucial in preventing CKD progression, with targets of <140/90 mmHg in patients without albuminuria and <130/80 mmHg in patients with albuminuria 3, 5
- Medical therapies aim to target epigenetic alterations, fibrosis, and inflammation, with approved treatments including RAAS blockade, sodium-glucose cotransporter-2 (SGLT2) inhibitors, pentoxifylline, and finerenone 3
- Atrasentan, an endothelin receptor antagonist (ERA), has been shown to decrease the risk of renal events in diabetic CKD patients 3
Nutritional Interventions
- A low-protein diet (LPD) can slow the progression of CKD 3
- Dietary changes, such as reducing sodium intake and increasing potassium intake, can help control blood pressure and slow CKD progression 5