[How to Retard Progression of Chronic Kidney Disease]

Area of Science:

• Nephrology
• Internal Medicine
• Pharmacology

Background:

• End-stage chronic kidney disease (CKD) significantly impairs quality of life and increases mortality.
• Therapeutic interventions are crucial for slowing the decline of renal function in CKD patients.
• General approaches to slow CKD progression are applicable across various underlying causes.

Purpose of the Study:

• To outline current and emerging therapeutic strategies for slowing the progression of chronic kidney disease.
• To highlight the importance of blood pressure management and specific pharmacotherapies in managing CKD.
• To discuss novel approaches like SGLT-2 inhibition and the correction of metabolic acidosis.

Main Methods:

• Review of established and investigational therapeutic interventions for CKD.
• Analysis of blood pressure targets and their impact on renal function.
• Evaluation of pharmacologic agents including renin-angiotensin system inhibitors, mineralocorticoid receptor antagonists, endothelin receptor antagonists, and SGLT-2 inhibitors.

Main Results:

• Lowering blood pressure to ≤140/90 mmHg (or ≤130/80 mmHg with albuminuria) is a primary intervention.
• Renin-angiotensin system inhibitors are recommended for patients with albuminuria, with specific guidelines based on diabetic status.
• Glycemic control (HbA1c ≈7.0%) slows progression in diabetic kidney disease, and SGLT-2 inhibition (e.g., empagliflozin) offers additional benefits.

Conclusions:

• Comprehensive management including blood pressure control, targeted pharmacotherapy, and glycemic control is essential for slowing CKD progression.
• Emerging therapies like SGLT-2 inhibitors and mineralocorticoid receptor blockers show promise but require further validation.
• Correction of metabolic acidosis and prevention of acute kidney injury are suggested protective measures against CKD advancement.