Chronic Kidney Disease:Treatment

Slowing the Progression of CKD

• Protein Restriction – KDOQI guidelines - 0.60-0.75 g/kg per day– Sufficient energy intake - 35 kcal/kg

• Reducing Intraglomerular Hypertension and Proteinuria– Antihypertensive therapy - 125/75 mmHg – ACE inhibitors and ARBs inhibit the

vasoconstriction of the efferent arterioles

• Slowing Progression of Diabetic Renal Disease

– Control of Blood Glucose• Preprandial plasma glucose - 5.0–7.2 mmol/L (90–130 mg/dL)• Hemoglobin A1C should be < 7%

– Use and dose of oral hypoglycemics needs to be reevaluated• Chlorpropamide - prolonged hypoglycemia• Metformin – lactic acidosis• Thiazolidinediones – increase renal salt and water reabsorption

– As renal function declines, less insulin is required for glycemic control

• Managing Other Complications of Chronic Kidney Disease– Medication Dose Adjustment• >70% excretion is non-renal –may not need adjustment• Metformin, meperidine, oral hypoglycemics and NSAIDs

should be avoided• Antibiotics, antihypertensives, and antiarrhythmics –

reduction in dosage or change in dose interval

– Preparation for Renal Replacement Therapy • Clear indications – pericarditis, encephalopathy,

intractable muscle cramping, anorexia, malnutrition, fluid and electrolyte abnormalities

• Recommendation for the optimal time for initiation of renal replacement therapy – Delaying renal replacement therapy leads to a

worse prognosis on dialysis or with transplantation

• Patient Education– Social, psychological, and physical preparation– Educational programs should be commenced no

later than stage 4 CKD