To effectively slow the progression of chronic kidney disease (CKD), it’s essential to integrate lifestyle changes, dietary adjustments, and pharmacological interventions, customized to address individual risks and comorbidities.
CKD is characterized by a decreased glomerular filtration rate (eGFR) or increased levels of albumin in urine, impacting 8–16% of the global population.
This condition leads to heightened morbidity and mortality and diminishes quality of life.
Using eGFR and the urine albumin-to-creatinine ratio for risk stratification is crucial for both prognosis and management, guided by the KDIGO staging system and risk prediction equations.
Core lifestyle changes include maintaining a healthy weight, engaging in regular physical activity, and quitting smoking, all of which help slow the progression of CKD and decrease cardiovascular risks.
Dietary changes should focus on a plant-based, low-sodium diet with moderate protein intake, while avoiding ultraprocessed foods.
For patients with an eGFR of less than 60 mL/min/1.73 m², it’s advised to limit daily protein intake to 0.8 g/kg of body weight, based on studies indicating that urea and other uremic toxins contribute to increased intraglomerular pressure, hyperfiltration, and kidney disease progression.
Despite the lack of large randomized controlled trials comparing various protein intake levels, low-protein diets are not advised for individuals at risk of malnutrition.
Controlling blood pressure is vital: the recommended target systolic blood pressure for CKD patients with hypertension is below 120 mm Hg when measured using standardized methods in an office setting.
For diabetic patients, maintaining optimal glycemic control (A1c around 7%) is advised to avert microvascular issues and slow CKD progress.
Pharmacological treatments include:
ACE inhibitors or ARBs for individuals with albuminuria and/or hypertension, avoiding dual blockade due to potential adverse effects.
Mineralocorticoid receptor antagonists may be used in specific instances, particularly for resistant hypertension or heart failure.
SGLT2 inhibitors (e.g., [e.g., dapagliflozin or empagliflozin]) have shown promise in CKD management, offering renal protection and additional cardiovascular benefits.