Why is treatment of Chronic Kidney Disease (CKD) necessary?

Why Treatment of Chronic Kidney Disease is Essential

Treatment of CKD is necessary to prevent kidney failure, reduce cardiovascular mortality, slow disease progression, and improve quality of life—outcomes that are now achievable through early detection and evidence-based interventions. 1

Prevention of Life-Threatening Outcomes

The primary imperative for treating CKD centers on preventing three catastrophic outcomes:

• Kidney failure requiring dialysis or transplantation can be prevented or delayed through early intervention 1
• Cardiovascular disease and premature death represent the most common adverse outcomes, with CKD patients facing cardiovascular death rates 10-30 times higher than the general population 2
• Progression to end-stage renal disease (ESRD) can be slowed significantly with appropriate therapy 1

Slowing Disease Progression

Treatment can achieve substantial delays in CKD progression and, in many cases, arrest the disease entirely: 1

• Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers reduce proteinuria and slow functional deterioration 1
• The RENAAL study demonstrated that losartan reduced the risk of doubling serum creatinine by 25% and ESRD by 29% in diabetic nephropathy 3
• Newer SGLT2 inhibitors and GLP-1 receptor agonists provide unprecedented opportunities to reduce progression risk 1
• Strict blood pressure control (target <130/80 mmHg) is essential for slowing progression 4, 5

Managing Systemic Complications

CKD disrupts multiple physiological systems, creating life-threatening complications that require treatment: 6

• Cardiovascular risk reduction through statins and blood pressure management prevents the leading cause of death in CKD patients 7
• Electrolyte abnormalities including hyperkalemia, hyperphosphatemia, and metabolic acidosis require monitoring and intervention 7, 8
• Anemia should be treated to target hemoglobin of 11-12 g/dL to improve quality of life 5
• Mineral-bone disease requires dietary phosphate restriction, phosphate binders, and vitamin D supplementation 5, 8

Improving Quality of Life and Functional Status

Beyond mortality reduction, treatment directly impacts patient well-being:

• Early intervention improves health status before patients reach dialysis, resulting in better outcomes when renal replacement therapy becomes necessary 1
• Treatment of complications like anemia, bone disease, and volume overload substantially improves daily functioning 1
• Patients with untreated CKD experience progressive decline in quality of life as complications accumulate 8

The Public Health Imperative

CKD represents a growing public health threat with increasing prevalence, high costs, and poor outcomes that demand systematic intervention: 1

• CKD affects 8-16% of the population worldwide and is the 16th leading cause of years of life lost globally 7
• Less than 5% of patients with early CKD are aware of their disease, making screening and early detection critical 7
• The incidence and prevalence of kidney failure continue to increase, with projected continued growth through 2020 and beyond 1
• CKD disproportionately affects racial and ethnic minorities, requiring targeted public health approaches 1

Treatment Reduces Residual Risk

Even with traditional therapies, patients face significant residual risk—newer treatments address this gap: 1

• Historical approaches (glycemic control, blood pressure management, renin-angiotensin system blockade) proved only partially effective 9
• SGLT2 inhibitors and GLP-1 receptor agonists now provide additional cardio-renal protection beyond traditional therapies 1, 9
• These "cardio-nephro-metabolic" drugs significantly impact both renal progression and cardiovascular prognosis 9

Early Detection Enables Effective Intervention

The rationale for treatment depends on early identification:

• CKD is silent in early stages but detectable through simple laboratory measurements (eGFR and albuminuria) 1, 7
• Treatment is most effective when initiated early, before irreversible damage occurs 1
• Patients with eGFR <30 mL/min/1.73m², albuminuria ≥300 mg/24h, or rapid eGFR decline require prompt nephrology referral 7

Common Pitfalls to Avoid

• Delaying treatment until symptoms appear: CKD is asymptomatic until advanced stages, making proactive screening essential 9
• Failing to address cardiovascular risk: Cardiovascular disease, not kidney failure, is the most common cause of death in CKD patients 2, 7
• Inadequate blood pressure control: Achieving target BP <130/80 mmHg is critical but often not reached 4
• Missing opportunities for newer therapies: SGLT2 inhibitors should be considered for all appropriate CKD patients, not just those with diabetes 1, 9