Chronic Kidney Disease: Treatment

Slowing the Progression of CKD Protein Restriction – KDOQI guidelines g/kg per day – Sufficient energy intake - 35 kcal/kg Reducing Intraglomerular Hypertension and Proteinuria – Antihypertensive therapy - 125/75 mmHg – ACE inhibitors and ARBs inhibit the vasoconstriction of the efferent arterioles

Slowing Progression of Diabetic Renal Disease – Control of Blood Glucose Preprandial plasma glucose - 5.0–7.2 mmol/L (90–130 mg/dL) Hemoglobin A 1C should be < 7% – Use and dose of oral hypoglycemics needs to be reevaluated Chlorpropamide - prolonged hypoglycemia Metformin – lactic acidosis Thiazolidinediones – increase renal salt and water reabsorption – As renal function declines, less insulin is required for glycemic control

Managing Other Complications of Chronic Kidney Disease – Medication Dose Adjustment >70% excretion is non-renal –may not need adjustment Metformin, meperidine, oral hypoglycemics and NSAIDs should be avoided Antibiotics, antihypertensives, and antiarrhythmics – reduction in dosage or change in dose interval – Preparation for Renal Replacement Therapy Clear indications – pericarditis, encephalopathy, intractable muscle cramping, anorexia, malnutrition, fluid and electrolyte abnormalities

Recommendation for the optimal time for initiation of renal replacement therapy – Delaying renal replacement therapy leads to a worse prognosis on dialysis or with transplantation Patient Education – Social, psychological, and physical preparation – Educational programs should be commenced no later than stage 4 CKD