[Progression inhibition in chronic kidney disease]

The KDIGO guidelines 2024 on evaluation and treatment of chronic kidney disease (CKD) represent a comprehensive update of the 2012 guidelines, incorporating evidence from over 937 references across 197 pages. The guidelines retain the established CGA classification system (cause, glomerular filtration rate, GFR category, albuminuria category) while introducing strengthened recommendations for prevention of CKD progression. Key advances include expanded indications for sodium-glucose transporter 2 (SGLT2) inhibitors regardless of diabetes status (grade 1A recommendation for eGFR ≥ 20 ml/min per 1.73 m² body surface area), integration of nonsteroidal mineralocorticoid receptor antagonists (ns-MRA) for diabetic CKD and recognition of glucagon-like peptide‑1 receptor agonists (GLP‑1 RA) for cardiovascular and kidney protection. The guidelines emphasize comprehensive risk stratification, lifestyle optimization including dietary protein restriction (0.8 g/kg and day) and sodium limitation (2 g/day), blood pressure targets (120 mm Hg systolic when tolerable) and combination pharmacotherapy. Emerging therapy approaches including endothelin receptor antagonists and aldosterone synthase inhibitors show promise in phase 2 trials. Meta-analyses demonstrate that combination therapy with SGLT2 inhibitors, GLP‑1 RA, and ns-MRA can extend cardiovascular and kidney event-free survival by 3-5 years in high-risk patients with type 2 diabetes.