CKD Management Guidelines
Introduction to CKD Treatment
- The KDIGO guidelines recommend SGLT2 inhibitors as first-line therapy for most patients with CKD, combined with RAS inhibition (ACE inhibitor or ARB) at maximum tolerated dose when hypertension or albuminuria is present, targeting systolic blood pressure <120 mm Hg, alongside statin-based lipid therapy 1, 2
First-Line Pharmacologic Therapy
- The KDIGO guidelines recommend SGLT2 inhibitors as first-line therapy for most CKD patients and should be continued until dialysis or transplant 1, 2, 3
- RAS inhibition (ACE inhibitor or ARB) at maximum tolerated dose is first-line when hypertension is present, and mandatory when albuminuria is present 1, 2, 3
- Statin therapy (moderate to high-intensity) is recommended for all adults ≥50 years with eGFR <60 mL/min/1.73 m² (CKD G3a-G5), using statin or statin/ezetimibe combination 3, 4
Blood Pressure Management
- Target SBP <120 mm Hg for most CKD patients 1, 2, 3
- When albuminuria is present: ACE inhibitor or ARB must be first-line 1, 2, 3
Advanced Pharmacotherapy
- Nonsteroidal mineralocorticoid receptor antagonists (ns-MRA) should be used in patients with diabetes 1, 2, 3
- Ezetimibe and PCSK9 inhibitors are indicated based on ASCVD risk and lipid levels 1, 2, 3, 4
Lifestyle Modifications
- 150 minutes per week of moderate-intensity physical activity is recommended, or to a level compatible with cardiovascular and physical tolerance 1, 2, 3
- Adopt healthy, diverse diets with higher consumption of plant-based foods compared to animal-based foods and lower consumption of ultraprocessed foods 1, 2, 3
- Protein intake of 0.8 g/kg body weight/day should be maintained in adults with CKD G3-G5 3
Management of Diabetes in CKD
- Manage hyperglycemia as per KDIGO Diabetes Guideline 1, 2, 3
- GLP-1 receptor agonists should be used where indicated 1, 2, 3
Cardiovascular Disease Management
- Low-dose aspirin is recommended for secondary prevention in CKD patients with established ischemic cardiovascular disease 4
- Non-vitamin K antagonist oral anticoagulants (NOACs) are preferred over vitamin K antagonists (warfarin) for thromboprophylaxis in atrial fibrillation in CKD G1-G4 4
Management of Metabolic Complications
- Do NOT use agents to lower serum uric acid in CKD patients with asymptomatic hyperuricemia to delay CKD progression 4
- Low-dose colchicine or glucocorticoids are preferable to NSAIDs for acute gout management 4, 5
Monitoring and Reassessment
- Regular risk factor reassessment every 3-6 months 2, 3
- Estimate 10-year cardiovascular risk using a validated risk tool 4