[Chronic kidney disease: therapy and care]

Area of Science:

• Nephrology
• Public Health

Context:

• Chronic kidney disease (CKD) represents a significant global health burden.
• Hypertension and proteinuria are key drivers of CKD progression, irrespective of the underlying cause.

Purpose:

• To outline strategies for slowing CKD progression and managing its complications.
• To emphasize the importance of blood pressure and proteinuria control in CKD management.

Summary:

• Optimal management includes strict blood pressure control (target <130/80 mmHg) and proteinuria reduction (<0.5 g/day) using renin-angiotensin system inhibitors.
• Reducing sodium intake can further enhance renoprotective effects.
• Early detection and management of CKD complications such as anemia, bone metabolism disorders, hyperkalemia, fluid overload, and metabolic acidosis are vital.
• Cardiovascular complications and risk factors require particular attention.
• Guidelines define monitoring parameters, with dialysis initiation typically considered at a glomerular filtration rate below 7 ml/min/1.73m² in the absence of uremic symptoms.
• Patient preparation for dialysis and evaluation for renal transplantation are essential components of CKD care.

Impact:

• Implementing these recommendations can significantly slow CKD progression, reduce the incidence of complications, and improve patient quality of life.
• Enhanced collaboration between nephrologists and primary care physicians ensures timely and effective interventions.
• Proactive management strategies can delay the need for renal replacement therapy and improve long-term patient outcomes.