Management of Chronic Kidney Disease Stage 3

Blood Pressure Management

The American College of Physicians recommends maintaining blood pressure ≤140/90 mmHg for patients without albuminuria and ≤130/80 mmHg for patients with albuminuria 1
The American College of Physicians suggests using ACE inhibitors or ARBs as first-line agents in all hypertensive CKD stage 3 patients, with ACE inhibitors having moderate-quality evidence and ARBs having high-quality evidence supporting their use 2
The American College of Physicians recommends mandatory use of ACE inhibitors or ARBs for patients with albuminuria >300 mg/24h 1

The Kidney International guideline recommends statin or statin/ezetimibe combination therapy for all patients ≥50 years with CKD stage 3, with high-quality evidence (1A) supporting this recommendation 5
The Kidney International guideline suggests initiating statin therapy in younger patients (18-49 years) with known coronary disease, prior ischemic stroke, or estimated 10-year cardiovascular risk >10% 5
The Kidney International guideline recommends maximizing absolute LDL cholesterol reduction to achieve largest treatment benefits and considering PCSK-9 inhibitors for patients with indications for their use 5

The American College of Physicians recommends sodium restriction to <2 g per day 1
The Kidney International guideline suggests a plant-dominant, Mediterranean-style diet to reduce cardiovascular risk and preserve renal function 5
The American College of Physicians recommends achieving and maintaining a healthy BMI of 20-25 kg/m², exercising 30 minutes, 5 times per week, and smoking cessation 1

The American College of Physicians recommends monitoring frequency based on GFR category and albuminuria level, with higher risk patients requiring more frequent monitoring 1
The American College of Physicians defines progression as a change in GFR category AND ≥25% decline in eGFR to avoid misinterpreting small fluctuations 1

The Kidney International guideline recommends low-dose aspirin for secondary prevention in patients with established ischemic cardiovascular disease 5
The Kidney International guideline suggests treating symptomatic hyperuricemia with uric acid-lowering therapy, but not treating asymptomatic hyperuricemia to delay CKD progression 5

The Kidney International guideline recommends maintaining optimal intravascular volume with isotonic crystalloids when expansion is needed and avoiding excessive diuresis with loop and thiazide diuretics 6