Chronic kidney disease or CKD is a condition where there is a gradual loss of kidney function over time. The latest management recommendations by the National Kidney Disease Education Program and Kidney Disease Outcomes Quality Initiative are penned down in this article.

Chronic kidney disease

Many chronic kidney disease  patients get treatment from primary care providers. The majority of patients with the chronic renal disease get primary care, where the main objective is to halt the progression and avoid complications. The treatment of patients with CKD aims to reduce the gradual loss of kidney function and avoid or manage consequences.

Important components of therapy include the control of diabetes and hypertension and the reduction of the risk of cardiovascular disease. The National Kidney Disease Education Program NKDEP and Kidney disease outcomes quality initiative KDOQI provide specific recommendations for primary care doctors, who treat the majority of patients.

1. Deal with hypertension:

1. Controlling blood pressure slows the course of CKD and reduces the risk of cardiovascular disease (CVD). RAAS antagonists increase the risk of hyperkalemia; hence, serum potassium levels must be monitored. Potassium levels of 5 mEq/L may be maintained with dietary potassium restriction.
2. Sodium restriction improves the effectiveness of RAAS antagonists.
3. Consider an ARB if a patient receiving an ACEi has a chronic nonproductive cough.
4. Use of ACEi and ARB together is contraindicated.

2. Decreasing albuminuria:

1. In albuminuria, high tubular protein levels may worsen kidney injury. Reduced albuminuria is connected with the slower development of chronic kidney disease, particularly in T2D patients. The purpose of therapy is to decrease or stabilize albumin loss in the urine.
2. RAAS blockers are suggested for all patients with CKD, however, the available data mostly supports its usage in individuals with albuminuria.
3. Cessation of smoking may also reduce albuminuria.

3. Manage type 2 diabetes:

1. Good management of newly diagnosed T2D may postpone the start or progression of CKD or both. Tight management of T2D of extended duration may not, however, delay the course of CKD.
2. Objectives for glycemic management should be individualized: an A1c target of 7% has been advised, with higher targets for individuals with a short life expectancy or an increased risk of hypoglycemia.
3. Changing the dosage of drugs may be necessary.

4. Recognize metabolic acidosis and correct it:

1. In individuals with CKD, decreased bicarbonate production and acid load excretion may raise the risk of metabolic acidosis.
2. Loss of bone and muscle mass, a negative nitrogen balance, increased protein catabolism, and reduced protein synthesis may occur from metabolic acidosis.
3. It has been proven that treatment of CKD-associated metabolic acidosis with oral alkali to produce a normal blood bicarbonate level (normal range, 21–28 mEq/L) slows the development of CKD.

5. Prevent acute renal damage:

1. Patients with CKD are more vulnerable to nephrotoxic substances and are at a high risk for AKI, which may hasten the course of CKD.
2. Avoid nephrotoxic medications and treatments that may exacerbate kidney damage, such as NSAIDs, quinolones, beta-lactams, and sulfonamides, to reduce the risk.
3. Caution should be used with the intravascular injection of iodinated contrast agents, and alternate imaging modalities should be considered.

6. Dietary control is the key:

1. For efficient nutritional treatment of CKD patients, address the following fundamental steps: Decrease salt consumption, reduce protein intake if excessive, replace solid or hydrogenated fats with liquid oil, restrict phosphorus, especially added phosphorus, and limit potassium when blood level is high.
2. For the treatment of hypoglycemia in individuals with T2DM and hyperkalemia, glucose tablets, cranberry juice cocktail, or apple juice are preferable to orange juice or cola.

7. Reduce the risk of cardiovascular problems:

1. Patients with CKD are at increased risk for cardiovascular disease, the primary cause of death in CKD. As opposed to LDL-C readings, primary care providers should commence statin-based treatment in patients aged 50 based on CVD risk factors.
2. Follow the suggested "fire and forget" strategy: eliminate correctable causes of secondary dyslipidemia, screen for risk factors warranting lipid-lowering treatment, commence when indicated, and do not remeasure LDL-C unless findings would modify care.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Monish Raut is a practising super specialist from New Delhi.