Comprehensive Management of Chronic Kidney Disease

Lifestyle Modifications

The American College of Cardiology recommends that patients with CKD undertake moderate-intensity physical activity for at least 150 minutes per week, adjusted to their cardiovascular and physical tolerance 1, 2
Patients with CKD should be encouraged to avoid sedentary behavior and maintain an active lifestyle 1, 2
Weight loss is recommended for patients with obesity and CKD 1
Patients with CKD should be advised to adopt healthy, diverse diets with higher consumption of plant-based foods compared to animal-based foods and lower consumption of ultra-processed foods 1, 3
Protein intake should be maintained at 0.8 g/kg body weight/day in adults with CKD G3-G5 1, 2
High protein intake (>1.3 g/kg body weight/day) should be avoided in adults with CKD at risk of progression 1, 2

The American Heart Association recommends targeting blood pressure <140/90 mmHg in CKD patients without albuminuria 2
A lower target of <130/80 mmHg is recommended for patients with albuminuria ≥30 mg/24h 2
Angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) should be used as first-line therapy, especially in patients with albuminuria 2

The American College of Cardiology recommends prescribing statins or statin/ezetimibe combination for adults ≥50 years with eGFR <60 ml/min/1.73 m² (CKD G3a-G5) 4, 2
Statins should be prescribed for adults ≥50 years with CKD and eGFR ≥60 ml/min/1.73 m² (CKD G1-G2) 4, 5
For adults aged 18-49 years with CKD, statin therapy should be considered for those with coronary disease, diabetes mellitus, prior ischemic stroke, or estimated 10-year incidence of coronary death or nonfatal MI >10% 4, 5
PCSK-9 inhibitors should be considered for people with CKD who have an indication for their use 5, 3
Oral low-dose aspirin is recommended for secondary prevention in people with CKD and established ischemic cardiovascular disease 5, 3

Validated risk prediction tools should be used to guide management decisions 2, 3
People at risk for CKD should be tested using both urine albumin measurement and assessment of glomerular filtration rate (GFR) 2

GFR should be considered when dosing medications cleared by the kidneys 2, 3
For most clinical settings, validated eGFR equations using serum creatinine are appropriate for drug dosing 2, 3
A thorough medication review should be performed periodically and at transitions of care to assess adherence, continued indication, and potential drug interactions 2, 3

Adults with CKD should be referred to specialist kidney care services when they have ACR ≥30 mg/g (3 mg/mmol) or PCR ≥200 mg/g (20 mg/mmol) 2, 3
Adults with CKD should be referred to specialist kidney care services when they have persistent hematuria 2, 3
Adults with CKD should be referred to specialist kidney care services when they have any sustained decrease in eGFR 2, 3

For children with CKD, physical activity should be encouraged aiming for WHO-advised levels (≥60 minutes daily) and achievement of healthy weight 1, 2
Protein intake should not be restricted in children with CKD due to risk of growth impairment 1, 2
For patients with atrial fibrillation and CKD G1-G4, non-vitamin K antagonist oral anticoagulants (NOACs) should be used in preference to vitamin K antagonists 5, 3