Therapeutic goals for mitigating chronic kidney disease progression in kidney transplant recipients: a 2024 update

In addition to allogeneic factors, kidney transplant recipients (KTR) remain exposed to non-allogeneic conditions, such as hypertension, proteinuria, anemia, bone mineral disorder, metabolic acidosis and hyperuricemia. These conditions contribute to the progression of chronic kidney disease (CKD). This paper reviews the latest updates on therapeutic goals and strategies to address these non-allogeneic risk factors.

We undertook a literature review regarding the current recommendations and therapeutic targets for the treatment of non-allogeneic risk factors for CKD progression in KTR, as of 2024.

As evidence is limited, some factors' treatment is based on native CKD. Well supported by studies on KTR, the blood pressure target should be below 130/80 mmHg, and proteinuria ideally be kept under 500 mg/day, whenever possible due to its multifactorial nature, preferably through the use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Revised optimal haemoglobin levels, and newly updated recommendations regarding treatment at earlier stages of bone mineral disorders, as well as other metabolic features and non-pharmacological interventions, are further addressed. A multidisciplinary approach with an individualized focus on treatment priorities for each patient leads to better therapeutic adherence and potentially improved outcomes.

We summarize the updated treatment goals for CKD in KTR, which are feasible to apply in daily practice and can contribute to better long-term patient and graft function survival.