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Therapeutic Considerations in Preventing Chronic Kidney Disease
Susanne B Nicholas1, Niloofar Nobakht1, Radica Z Alicic2,3
1Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA;
Insights
Early screening for chronic kidney disease (CKD) is crucial as most patients are unaware. Advanced therapies and multidisciplinary care are revolutionizing CKD management and reducing cardiovascular risks.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Chronic kidney disease (CKD) impacts millions, yet diagnosis rates are low due to asymptomatic progression.
- Cardiovascular disease is the leading cause of mortality in CKD patients.
- Cardiovascular-kidney-metabolic syndrome underscores the interconnectedness of heart, kidney, and metabolic health.
Purpose of the Study:
- To emphasize the importance of early CKD screening in at-risk populations.
- To highlight the role of diagnostic markers in CKD staging and risk assessment.
- To discuss advancements in CKD management and the integrated care approach.
Main Methods:
- Utilizing urine albumin-to-creatinine ratio and estimated glomerular filtration rate for CKD classification and risk stratification.
- Reviewing current guideline-directed medical therapies and standard-of-care treatments.
- Examining the impact of cardiovascular-kidney-metabolic syndrome on organ health.
Main Results:
- Urine albumin-to-creatinine ratio and estimated glomerular filtration rate effectively classify CKD stages and predict progression risk.
- Novel therapies like SGLT2 inhibitors and GLP-1 receptor agonists, alongside ACE inhibitors/ARBs, significantly improve CKD outcomes.
- A multidisciplinary approach is optimal for managing complex CKD cases.
Conclusions:
- Prompt CKD screening is essential for early intervention and improved patient outcomes.
- Integrated management of cardiovascular, kidney, and metabolic disorders is critical.
- Modern pharmacotherapies and collaborative care models represent a paradigm shift in CKD treatment.
Abstract:
Chronic kidney disease (CKD) affects 35.5 million US adults, but most patients are unaware of their diagnosis. Screening for CKD at-risk individuals is required, as symptoms do not appear until advanced stages. The combination of urine albumin-to-creatinine ratio and estimated glomerular filtration rate permits the classification of CKD stages and the determination of risk of CKD progression and cardiovascular disease, which is the most common cause of death in CKD. Cardiovascular-kidney-metabolic syndrome highlights the complex interplay between the heart, kidney, and metabolic disorders, such as diabetes and dysfunctional obesity, which promotes chronic inflammation, leading to injury in these organs and systems. New guideline-directed medical therapies consisting of sodium-glucose cotransporter 2 inhibitors, glucose-like peptide-1 receptor agonists, and nonsteroidal mineralocorticoid receptor antagonists, in addition to standard-of-care therapies including angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, have revolutionized CKD management, which may be best facilitated through a multidisciplinary care approach.
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