Initial Treatment Approach for CKD Grade 1/2

Lifestyle Modifications

The American College of Cardiology recommends encouraging moderate-intensity physical activity for at least 150 minutes per week to improve cardiovascular health and slow CKD progression 1
A plant-based "Mediterranean-style" diet is recommended to reduce cardiovascular risk and support kidney health 2
Patients should be advised to achieve optimal body mass index through weight management 1
Complete cessation of tobacco products is strongly recommended 1
Consider referral to specialized providers (renal dietitians, physical therapists, smoking cessation programs) when appropriate 1

The American Heart Association recommends aiming for systolic blood pressure <120 mmHg 1
First-line pharmacotherapy should include a renin-angiotensin system (RAS) inhibitor (ACE inhibitor or ARB) at maximum tolerated dose, particularly when albuminuria is present 1
Blood pressure should be monitored regularly, preferably using 24-hour ambulatory devices for accurate assessment 3
Dihydropyridine calcium channel blockers and/or diuretics can be added if needed to achieve individualized blood pressure targets 1
For patients with diabetes, non-steroidal mineralocorticoid receptor antagonists can be considered 1

SGLT2 inhibitors are recommended as first-line drug therapy for most patients with CKD grade 1/2, regardless of diabetes status 1
For patients aged ≥50 years, statin therapy is recommended to reduce cardiovascular risk 2, 3
For patients aged 18-49 years, statin therapy can be suggested if they have coronary disease, diabetes mellitus, prior ischemic stroke, or estimated 10-year cardiovascular risk >10% 2, 4
Low-dose aspirin can be considered for secondary prevention in patients with established cardiovascular disease 2, 4
For patients with diabetes, KDIGO Diabetes Guidelines should be followed, including use of GLP-1 receptor agonists where indicated 1

All medications should be reviewed for appropriate dosing in CKD 3
Nephrotoxic medications, particularly NSAIDs, should be avoided as they can worsen kidney function 3
Drug interactions should be monitored and doses adjusted as needed based on kidney function 3

RAS inhibitors should not be discontinued prematurely due to initial creatinine elevation (up to 30% increase can be acceptable) 1
Modifiable risk factors such as smoking, obesity, and sedentary lifestyle should be addressed 1
SGLT2 inhibitors should not be delayed as they have shown significant benefits in slowing CKD progression 1