Treatment of Chronic Kidney Disease (CKD)
CKD is progressive, irreversible loss of kidney function over months to years, classified in stages 1-5 based on GFR. Diabetes and hypertension are the leading causes; management focuses on slowing progression and managing complications.
Managing Chronic Kidney Disease (CKD) effectively requires a combination of medical treatment, lifestyle modification, and regular monitoring. With a structured management plan, most people with Chronic Kidney Disease (CKD) can maintain a good quality of life and prevent serious complications.
First-Line Treatment Principles
- ✓BP control: target <130/80 mmHg; ACE inhibitor or ARB for proteinuric CKD
- ✓SGLT2 inhibitors for CKD with proteinuria (regardless of diabetes): reduce CKD progression by 30–40%
- ✓Treat underlying cause: immunosuppression for glomerulonephritis, antiviral for viral-associated nephropathy
- ✓Fluid management: adequate hydration in AKI; fluid restriction in oliguric/ESRD patients
- ✓Treat complications: anaemia (EPO/iron), bone disease (phosphate binders, vitamin D), hyperkalaemia
What to Do Now
- Learn your personal risk factors for Chronic Kidney Disease (CKD) (family history, age, lifestyle)
- Attend regular health check-ups and screening tests appropriate for your age and risk
- Track new or changing symptoms, especially those associated with Chronic Kidney Disease (CKD)
- Use our AI symptom checker to assess whether your symptoms fit an early Chronic Kidney Disease (CKD) pattern
- Discuss preventive strategies and early monitoring with your GP
- Build a personalised management plan with your GP or specialist
- Adhere consistently to prescribed medications — do not stop without medical advice
- Adopt a Chronic Kidney Disease (CKD)-appropriate diet (anti-inflammatory, low-glycaemic, or disease-specific)
Medications Used in Chronic Kidney Disease (CKD)
Empagliflozin is an SGLT-2 inhibitor that lowers blood glucose by promoting urinary glucose excretion, with additional benefits for heart and kidney protection.
Dapagliflozin is an SGLT-2 inhibitor that lowers blood glucose by promoting urinary glucose excretion, with additional benefits for heart and kidney protection.
Canagliflozin is an SGLT-2 inhibitor that lowers blood glucose by promoting urinary glucose excretion, with additional benefits for heart and kidney protection.
Ertugliflozin is an SGLT-2 inhibitor that lowers blood glucose by promoting urinary glucose excretion, with additional benefits for heart and kidney protection.
Enalapril is an ACE inhibitor that lowers blood pressure, reduces cardiac workload, and provides kidney protection in hypertension, heart failure, and diabetic nephropathy.
Lisinopril is an ACE inhibitor that lowers blood pressure, reduces cardiac workload, and provides kidney protection in hypertension, heart failure, and diabetic nephropathy.
Ramipril is an ACE inhibitor that lowers blood pressure, reduces cardiac workload, and provides kidney protection in hypertension, heart failure, and diabetic nephropathy.
Perindopril is an ACE inhibitor that lowers blood pressure, reduces cardiac workload, and provides kidney protection in hypertension, heart failure, and diabetic nephropathy.
Non-Pharmacological Management
- •Dietary protein restriction (0.6–0.8 g/kg/day) in advanced CKD to slow progression
- •Sodium restriction (<2g/day) for BP and fluid management
- •Potassium restriction in hyperkalaemia; phosphate restriction in ESRD
- •Fluid management: adequate intake in early CKD; restrict to 1.0–1.5L/day in oliguric ESRD
- •Smoking cessation: accelerates CKD progression
- •Weight management: obesity drives glomerular hyperfiltration and proteinuria
- •Regular aerobic exercise where tolerated; renal rehabilitation programmes
Treatment Goals
Monitoring Parameters
- ◆eGFR and creatinine: 3–6 monthly in CKD stages 3–4; monthly in CKD stage 5 or rapid progressors
- ◆Urine albumin-creatinine ratio (UACR): every 3–6 months
- ◆Electrolytes: potassium (ACE inhibitor/ARB risk), sodium, bicarbonate, phosphate — 3–6 monthly
- ◆FBC: haemoglobin target 100–120 g/L with EPO therapy
- ◆Parathyroid hormone (PTH), calcium, phosphate: for renal bone disease monitoring
- ◆BP: target at every visit
Red Flags — When to Escalate
- ⚠Any of the characteristic symptoms of Chronic Kidney Disease (CKD) — even mild — in a high-risk individual
- ⚠Progressive worsening of early warning signs over weeks
- ⚠Laboratory abnormalities (e.g., blood sugar, inflammatory markers) without full symptoms
- ⚠Unexplained weight loss, night sweats, or fatigue persisting >2 weeks
- ⚠Strong family history of Chronic Kidney Disease (CKD) combined with new relevant symptoms
- ⚠Sudden worsening of Chronic Kidney Disease (CKD) symptoms despite established treatment
Escalation Criteria
- →AKI: urgent assessment for reversible causes; IV fluids if pre-renal; emergency dialysis if urea >35, K+>6.5, acidosis, or fluid overload
- →Rapidly progressive GFR decline → renal biopsy and specialist nephrology review
- →Hyperkalaemia >6.5 mmol/L: immediate cardiac monitoring, calcium gluconate IV, insulin-dextrose, dialysis if refractory
- →Prepare for renal replacement therapy (RRT) education when eGFR <20: home dialysis or transplant listing
Special Populations
Clinical Insights
Compare With Similar Conditions
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