Slowing CKD Progression with Pharmacologic and Lifestyle Interventions

Primary Pharmacologic Interventions

The American Diabetes Association recommends starting with ACE inhibitors or ARBs for patients with albuminuria ≥30 mg/g, optimizing blood pressure to ≤130/80 mmHg if albuminuria is present, and adding SGLT2 inhibitors for diabetic CKD patients with eGFR ≥20 mL/min/1.73 m² 1, 2
For moderately increased albuminuria (30-299 mg/g), ACE inhibitor or ARB is recommended to slow CKD progression 1
For severely increased albuminuria (≥300 mg/g) and/or eGFR <60 mL/min/1.73 m², ACE inhibitor or ARB is strongly recommended to prevent kidney disease progression and reduce cardiovascular events 1
The American College of Cardiology recommends that these agents reduce proteinuria and consistently slow progression in both diabetic and non-diabetic nephropathy 2

The American Heart Association recommends targeting BP ≤130/80 mmHg for patients with albuminuria ≥30 mg/24 hours to slow CKD progression 1, 2
For patients with urine albumin excretion <30 mg/24 hours, target BP ≤140/90 mmHg 2, 4
Blood pressure control and reducing BP variability are critical to slow CKD progression, according to the American Diabetes Association 1

The American Diabetes Association recommends optimizing glucose management to reduce risk and slow CKD progression, targeting HbA1c approximately 7% 1, 4
Metformin is recommended as first-line when eGFR ≥30 mL/min/1.73 m² 4
SGLT2 inhibitors should be added when eGFR ≥20 mL/min/1.73 m² 4

The National Kidney Foundation recommends limiting protein intake to maximum 0.8 g/kg body weight/day for stage 3 or higher CKD 3, 4
Sodium restriction to <2 g per day is recommended to control BP and reduce proteinuria 2, 4
A Mediterranean-style diet is recommended to reduce cardiovascular risk 2

The American College of Cardiology recommends prescribing statins for all adults aged ≥50 years with CKD regardless of GFR category 4
For adults 18-49 years, statins should be used if they have coronary disease, diabetes, prior stroke, or 10-year coronary event risk >10% 4

The National Kidney Foundation recommends monitoring urinary albumin and eGFR 1-4 times per year depending on CKD stage 1
For patients with severely increased albuminuria (≥300 mg/g), target a 30% or greater reduction in urinary albumin to slow progression 3

The American Diabetes Association recommends considering treating metabolic acidosis when serum bicarbonate <18 mmol/L 4
Monitoring should ensure bicarbonate doesn't exceed upper limit of normal or adversely affect BP, potassium, or fluid status 4