Management of Chronic Kidney Disease

Introduction to CKD Management

• The American Heart Association recommends systolic BP <120 mmHg for optimal cardiovascular protection in CKD 2
• For patients with CKD and albuminuria (30-300 mg/24h equivalent), the target BP is <130/80 mmHg 3, 1

Blood Pressure Management

• The target blood pressure should be <130/80 mmHg, and the first-line agent must be an ACE inhibitor or ARB titrated to maximum tolerated dose 3, 4, 2
• ACE inhibitor or ARB therapy should be initiated and titrated to the highest approved dose tolerated for patients with diabetes, hypertension, and albuminuria 4
• RAS inhibition is the cornerstone of therapy for patients with albuminuria and hypertension 4, 2

Additional Pharmacological Interventions

• This patient requires immediate initiation of both an SGLT2 inhibitor and statin therapy to reduce cardiovascular and kidney disease progression risk 6, 2
• SGLT2 inhibitors are first-line therapy for patients with type 2 diabetes and CKD, regardless of glycemic control 2
• For adults aged ≥50 years with CKD Stage 3, statin or statin/ezetimibe combination is strongly recommended (Grade 1A) 6, 1

Lifestyle Modifications

• Sodium restriction and Mediterranean-style diet are the highest priority lifestyle interventions, followed by structured exercise and weight loss 6, 2
• Plant-based "Mediterranean-style" diet reduces cardiovascular risk and supports kidney health 6, 2, 1
• Moderate-intensity physical activity for at least 150 minutes per week improves cardiovascular health and slows CKD progression 2

Medication Management

• NSAIDs are absolutely contraindicated as they worsen kidney function and increase cardiovascular risk 2, 1
• Metformin can be continued with caution at eGFR 52 mL/min/1.73 m², with monitoring 1
• All medications require review for appropriate CKD dosing 1

Monitoring and Referral

• Monitor serum creatinine, potassium, and albuminuria every 3-6 months, with nephrology referral indicated if eGFR declines rapidly or albuminuria worsens significantly 2, 1
• Refer to nephrology if rapid decline in eGFR (>5 mL/min/1.73 m² per year), eGFR falls below 30 mL/min/1.73 m², or albuminuria ≥300 mg/24h despite optimal therapy 1