24th June 2023

Management of chronic kidney disease

Management of chronic kidney disease has four key components:

• Treatment of the underlying cause, if possible, e.g. specific treatment for a vasculitis or myeloma
• Prevent the progression of CKD:
  • Controlling blood pressure – NICE recommends a target of <140/90 for patients with CKD and a target of <130/80 if significant proteinuria (ACR of >70mg/mmol)
  • Reducing proteinuria – this has traditionally been addressed with an angiotensin receptor blocker (ARB) or an angiotensin-converting enzyme (ACE) inhibitor titrated up to the highest dose tolerated. More recent evidence has supported the use of sodium glucose co-transporter-2 (SGLT2) inhibitors in addition to the above.
  • Improving glycaemic control in diabetics.
  • Dietary modifications – low phosphate, low potassium, salt-restriction, and fluid-restriction if needed
• Identify and treat any complications of CKD – e.g. anaemia, renal bone disease, hyperkalaemia, metabolic acidosis, fluid overload, cardiovascular disease.
• Prepare for renal replacement therapy if appropriate, or consider discussions about conservative/palliative care.