What are the management strategies for Chronic Kidney Disease (CKD)?

From the Guidelines

The management of chronic kidney disease (CKD) should focus on a comprehensive strategy to reduce risks of kidney disease progression and cardiovascular disease, as recommended by the 2022 KDIGO clinical practice guideline for diabetes management in CKD 1.

Key Components of CKD Management

• Glycemic control: Using metformin and sodium-glucose cotransporter-2 inhibitors (SGLT2i) for type 2 diabetes, with a target hemoglobin A1c (HbA1c) level based on individual risk factors and comorbidities.
• Blood pressure control: Targeting blood pressure <130/80 mmHg, with the use of renin-angiotensin system (RAS) inhibitors, such as ACE inhibitors or ARBs, in patients with albuminuria or hypertension.
• Lipid management: Using statins to reduce cardiovascular risk, with a target low-density lipoprotein (LDL) cholesterol level based on individual risk factors and comorbidities.
• Lifestyle modifications: Encouraging a healthy diet, regular exercise, smoking cessation, and weight management to reduce cardiovascular risk and slow CKD progression.

Additional Considerations

• Regular risk factor reassessment: Every 3-6 months to monitor disease progression and adjust treatment as needed.
• Mineral bone disorder management: Using phosphate binders, vitamin D supplements, and calcimimetics as indicated to manage mineral and bone disorders.
• Anemia management: Using erythropoiesis-stimulating agents and iron supplementation to manage anemia and target a hemoglobin level of 10-11.5 g/dL.
• Nephrology referral: Recommended at GFR <30 mL/min/1.73m² to facilitate early planning for renal replacement therapy and improve patient outcomes.

Evidence-Based Recommendations

The 2022 KDIGO clinical practice guideline for diabetes management in CKD provides evidence-based recommendations for the management of CKD, including the use of SGLT2i and GLP-1 receptor agonists to reduce kidney disease progression and cardiovascular risk 1. The guideline also emphasizes the importance of individualized treatment and regular monitoring to optimize patient outcomes.

From the Research

Management of CKD

The management of Chronic Kidney Disease (CKD) is complex and requires a multidisciplinary approach 2. The current management guidelines for CKD emphasize the importance of early detection and management of CKD, as well as the need for a multidisciplinary approach to its management.

Interventions to Slow CKD Progression

Several interventions can slow the progression of CKD, including:

• Blood pressure control 2, 3
• Glycemic control in diabetic patients 2, 3
• Reduction of proteinuria 2, 3
• Lifestyle modifications, such as:
  • Dietary changes 3, 4, 5, 6
  • Physical activity 3, 4, 5
  • Smoking cessation 3, 4
  • Weight management 3, 4, 5
• Medical therapies, such as:
  • RAAS blockade 3
  • Sodium-glucose cotransporter-2 (SGLT2) inhibitors 3
  • Pentoxifylline 3
  • Finerenone 3

Lifestyle Modifications

Lifestyle modifications play a crucial role in the management of CKD. Studies have shown that lifestyle interventions, such as diet and exercise, can improve kidney function and reduce the risk of CKD progression 4, 5. A plant-dominant low-protein diet has been shown to reduce the risk of developing incident CKD, CKD progression, and its related complications 6.

Monitoring and Referral

Regular monitoring of kidney function and referral to a nephrologist for patients with advanced CKD or other complications are also important aspects of CKD management 2.