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Advances in the management of chronic kidney disease
Teresa K Chen1, Melanie P Hoenig2, Dorothea Nitsch3
1Kidney Health Research Collaborative and Division of Nephrology, Department of Medicine, University of California San Francisco; and San Francisco VA Health Care System, San Francisco, CA, USA.
Insights
Chronic kidney disease (CKD) is a global health issue often unrecognized. Early detection and management, including new therapies, can significantly improve patient outcomes and reduce kidney failure.
Area of Science:
- Nephrology
- Public Health
- Internal Medicine
Background:
- Chronic kidney disease (CKD) is a significant global health concern with low patient and provider awareness.
- CKD is defined by persistent kidney structure or function abnormalities (low GFR or albuminuria) detectable by standard tests.
- Early CKD recognition is vital for effective staging, prognosis, and treatment.
Purpose of the Study:
- To review current evidence on general CKD management principles.
- To discuss individualized treatment strategies based on CKD risk and cause.
- To highlight novel kidney-protective agents.
Main Methods:
- Review of evidence-based general CKD management strategies.
- Discussion of individualized treatment approaches.
- Overview of emerging therapeutic classes for kidney protection.
Main Results:
- General management includes blood pressure and glucose control, RAAS blockade, statins, and diet.
- Individualized treatment considers risk of kidney failure and CKD etiology.
- Novel agents like SGLT2 inhibitors and GLP-1 RAs show promise.
Conclusions:
- Widespread implementation of effective CKD therapies can improve patient lives.
- Timely and appropriate treatment can decrease the global incidence of kidney failure.
- Advances in staging, prognosis, and treatment offer new hope for CKD patients.
Abstract:
Chronic kidney disease (CKD) represents a global public health crisis, but awareness by patients and providers is poor. Defined as persistent abnormalities in kidney structure or function for more than three months, manifested as either low glomerular filtration rate or presence of a marker of kidney damage such as albuminuria, CKD can be identified through readily available blood and urine tests. Early recognition of CKD is crucial for harnessing major advances in staging, prognosis, and treatment. This review discusses the evidence behind the general principles of CKD management, such as blood pressure and glucose control, renin-angiotensin-aldosterone system blockade, statin therapy, and dietary management. It additionally describes individualized approaches to treatment based on risk of kidney failure and cause of CKD. Finally, it reviews novel classes of kidney protective agents including sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, non-steroidal selective mineralocorticoid receptor antagonists, and endothelin receptor antagonists. Appropriate, widespread implementation of these highly effective therapies should improve the lives of people with CKD and decrease the worldwide incidence of kidney failure.
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