From the Guidelines
Management of Chronic Kidney Disease (CKD) stage 3 should prioritize blood pressure control, targeting below 130/80 mmHg, and pharmacologic therapy with either an angiotensin-converting enzyme inhibitor or an angiotensin II-receptor blocker, as recommended by the American College of Physicians 1.
Key Recommendations
- Blood pressure control: Targeting below 130/80 mmHg using ACE inhibitors (like lisinopril 10-40 mg daily) or ARBs (such as losartan 25-100 mg daily) as first-line agents.
- Pharmacologic therapy: Selecting either an angiotensin-converting enzyme inhibitor or an angiotensin II-receptor blocker for patients with hypertension and stage 1 to 3 CKD, as recommended by the American College of Physicians 1.
- Statin therapy: Choosing statin therapy to manage elevated low-density lipoprotein in patients with stage 1 to 3 CKD, as recommended by the American College of Physicians 1.
- Lifestyle modifications: Encouraging lifestyle changes, such as smoking cessation, sodium restriction, and moderate protein intake, to slow disease progression and reduce cardiovascular risk.
- Regular monitoring: Checking eGFR and electrolytes every 3-6 months to monitor disease progression and adjust treatment as needed.
- Metabolic complications: Addressing metabolic complications, including anemia, vitamin D deficiency, and mineral bone disorders, to improve quality of life and reduce morbidity.
- Cardiovascular risk reduction: Reducing cardiovascular risk through statin therapy and lifestyle modifications, as CKD increases cardiovascular risk.
- Nephrotoxic medications: Avoiding nephrotoxic medications like NSAIDs and adjusting medication dosages based on kidney function to minimize harm.
- Patient education: Educating patients about their condition and providing early nephrology referral, typically when eGFR falls below 45 ml/min/1.73m², to ensure comprehensive care and preparation for potential disease progression.
Recent Guidelines
The 2021 Kidney Disease: Improving Global Outcomes (KDIGO) controversies conference recommends early identification and intervention of CKD, including lifestyle modification, smoking cessation, RAS inhibition, and statin therapy 1. The conference also highlights the importance of individualized treatment and patient education in managing CKD.
Prioritizing Morbidity, Mortality, and Quality of Life
In managing CKD stage 3, it is essential to prioritize morbidity, mortality, and quality of life outcomes. This can be achieved by:
- Controlling blood pressure and proteinuria to slow disease progression
- Managing metabolic complications to improve quality of life
- Reducing cardiovascular risk to minimize morbidity and mortality
- Providing patient education and early nephrology referral to ensure comprehensive care and preparation for potential disease progression.
From the Research
Management Recommendations for CKD Stage 3
The management of Chronic Kidney Disease (CKD) stage 3 involves controlling blood pressure and slowing the progression of kidney disease. The following are some management recommendations:
- Blood pressure control: The recommended blood pressure goal for patients with CKD stage 3 is less than 130/80 mmHg 2 or less than 140/90 mmHg 3, 4.
- Lifestyle modifications: Lifestyle modifications such as diet and exercise are important for managing CKD stage 3.
- Medications: Angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) are recommended as first-line treatments for CKD stage 3 2, 5.
- Monitoring: Regular monitoring of blood pressure, kidney function, and proteinuria is important for managing CKD stage 3.
Treatment Options
The following are some treatment options for CKD stage 3:
- ACE inhibitors: ACE inhibitors are recommended as first-line treatments for CKD stage 3 2, 5.
- ARBs: ARBs are recommended as alternative treatments for CKD stage 3 if ACE inhibitors are not tolerated 2.
- Diuretics: Diuretics are commonly used in the management of CKD stage 3 2.
- Non-dihydropyridine CCBs: Non-dihydropyridine CCBs can be used in combination with a RAAS blocker to reduce albuminuria and slow the decline in kidney function 2.
- Dihydropyridine CCBs: Dihydropyridine CCBs should not be used as monotherapy in proteinuric CKD patients but always in combination with a RAAS blocker 2.
Factors Associated with Blood Pressure Control
The following are some factors associated with blood pressure control in CKD stage 3:
- Age: Older patients are less likely to achieve blood pressure targets 6.
- Diabetes: Patients with diabetes are less likely to achieve blood pressure targets 6.
- Albuminuria: Patients with albuminuria are less likely to achieve blood pressure targets 6.
- Sex: Male patients may be less likely to achieve blood pressure targets 6.