Other measures
[edit]
Aggressive treatment of high blood lipids is recommended.[79] Statins are
recommended for those with CKD older than 50 years old, and those younger if
certain other indications exist.[27]
Certain medications that are cleared from the body by the kidneys may need
dose adjustments or discontinuation in those with chronic kidney disease to
prevent accumulation of the medications in the body.[27]
Sodium-glucose cotransporter-2 (SGLT2) inhibitors are recommended by the
2024 KDIGO guideline to slow CKD progression in adults with eGFR ≥20
mL/min/1.73 m² who have type 2 diabetes, heart failure, or
significant albuminuria, with benefits seen regardless of diabetes status.[80] In the
DAPA-CKD trial, dapagliflozin reduced a composite of sustained eGFR decline,
end-stage kidney disease, or kidney or cardiovascular death compared with
placebo in patients with CKD with or without type 2 diabetes.[81] The EMPA-
KIDNEY trial reported a similar benefit for empagliflozin across a broader CKD
population, including patients without diabetes.[82]
The 2024 KDIGO guideline suggests a protein intake of approximately 0.8 g/kg
body weight per day in metabolically stable adults with CKD stages G3–G5, and
recommends avoiding high protein intake (>1.3 g/kg/d) in those at risk of
progression.[80] A more restrictive very-low-protein diet (0.3–0.4 g/kg/d)
supplemented with essential amino acids or ketoacid analogues may be
considered in selected patients at risk of kidney failure who are willing and able
to follow it, under close supervision; it is not appropriate for people who are
metabolically unstable, frail, sarcopenic, or undernourished, and is not
recommended for children due to growth concerns.[80] The earlier evidence base
for unsupplemented low-protein diets predates widespread use of RAS
inhibitors and SGLT2 inhibitors, and protein restriction alone has weaker support
than these pharmacological therapies for slowing CKD progression.[83]
Anemia – A target hemoglobin level of 100–120 g/L is recommended;[84][85] raising
hemoglobin levels to the normal range has not been found to be of benefit.[86]
Guidelines recommend treatment with parenteral iron prior to treatment
with erythropoietin.
Replacement of erythropoietin is often necessary in people with advanced
disease.[87]
It is unclear if androgens improve anemia.[88]
Calcitriol is recommended for vitamin D deficiency and control of metabolic bone
disease.
Phosphate binders are used to control the serum phosphate levels, which are
usually elevated in advanced chronic kidney disease.
Phosphodiesterase-5 inhibitors and zinc may improve sexual dysfunction in men.
[48]
Gadolinium based MRI contrast agents are contraindicated in those with GFR
less than 30 (stage 4 kidney disease) due to the risk of nephrogenic systemic
fibrosis. However, this risk is believed to be low in people with CKD, with newer
contrast agents being used.[27]
Other measures
[edit]
Aggressive treatment of high blood lipids is recommended.[79] Statins are
recommended for those with CKD older than 50 years old, and those younger if
certain other indications exist.[27]
Certain medications that are cleared from the body by the kidneys may need
dose adjustments or discontinuation in those with chronic kidney disease to
prevent accumulation of the medications in the body.[27]
Sodium-glucose cotransporter-2 (SGLT2) inhibitors are recommended by the
2024 KDIGO guideline to slow CKD progression in adults with eGFR ≥20
mL/min/1.73 m² who have type 2 diabetes, heart failure, or
significant albuminuria, with benefits seen regardless of diabetes status.[80] In the
DAPA-CKD trial, dapagliflozin reduced a composite of sustained eGFR decline,
end-stage kidney disease, or kidney or cardiovascular death compared with
placebo in patients with CKD with or without type 2 diabetes.[81] The EMPA-
KIDNEY trial reported a similar benefit for empagliflozin across a broader CKD
population, including patients without diabetes.[82]
The 2024 KDIGO guideline suggests a protein intake of approximately 0.8 g/kg
body weight per day in metabolically stable adults with CKD stages G3–G5, and
recommends avoiding high protein intake (>1.3 g/kg/d) in those at risk of
progression.[80] A more restrictive very-low-protein diet (0.3–0.4 g/kg/d)
supplemented with essential amino acids or ketoacid analogues may be
considered in selected patients at risk of kidney failure who are willing and able
to follow it, under close supervision; it is not appropriate for people who are
metabolically unstable, frail, sarcopenic, or undernourished, and is not
recommended for children due to growth concerns.[80] The earlier evidence base
for unsupplemented low-protein diets predates widespread use of RAS
inhibitors and SGLT2 inhibitors, and protein restriction alone has weaker support
than these pharmacological therapies for slowing CKD progression.[83]
Anemia – A target hemoglobin level of 100–120 g/L is recommended;[84][85] raising
hemoglobin levels to the normal range has not been found to be of benefit.[86]
Guidelines recommend treatment with parenteral iron prior to treatment
with erythropoietin.
Replacement of erythropoietin is often necessary in people with advanced
disease.[87]
It is unclear if androgens improve anemia.[88]
Calcitriol is recommended for vitamin D deficiency and control of metabolic bone
disease.
Phosphate binders are used to control the serum phosphate levels, which are
usually elevated in advanced chronic kidney disease.
Phosphodiesterase-5 inhibitors and zinc may improve sexual dysfunction in men.
[48]
Gadolinium based MRI contrast agents are contraindicated in those with GFR
less than 30 (stage 4 kidney disease) due to the risk of nephrogenic systemic
fibrosis. However, this risk is believed to be low in people with CKD, with newer
contrast agents being used.[27]
Other measures
[edit]
Aggressive treatment of high blood lipids is recommended.[79] Statins are
recommended for those with CKD older than 50 years old, and those younger if
certain other indications exist.[27]
Certain medications that are cleared from the body by the kidneys may need
dose adjustments or discontinuation in those with chronic kidney disease to
prevent accumulation of the medications in the body.[27]
Sodium-glucose cotransporter-2 (SGLT2) inhibitors are recommended by the
2024 KDIGO guideline to slow CKD progression in adults with eGFR ≥20
mL/min/1.73 m² who have type 2 diabetes, heart failure, or
significant albuminuria, with benefits seen regardless of diabetes status.[80] In the
DAPA-CKD trial, dapagliflozin reduced a composite of sustained eGFR decline,
end-stage kidney disease, or kidney or cardiovascular death compared with
placebo in patients with CKD with or without type 2 diabetes.[81] The EMPA-
KIDNEY trial reported a similar benefit for empagliflozin across a broader CKD
population, including patients without diabetes.[82]
The 2024 KDIGO guideline suggests a protein intake of approximately 0.8 g/kg
body weight per day in metabolically stable adults with CKD stages G3–G5, and
recommends avoiding high protein intake (>1.3 g/kg/d) in those at risk of
progression.[80] A more restrictive very-low-protein diet (0.3–0.4 g/kg/d)
supplemented with essential amino acids or ketoacid analogues may be
considered in selected patients at risk of kidney failure who are willing and able
to follow it, under close supervision; it is not appropriate for people who are
metabolically unstable, frail, sarcopenic, or undernourished, and is not
recommended for children due to growth concerns.[80] The earlier evidence base
for unsupplemented low-protein diets predates widespread use of RAS
inhibitors and SGLT2 inhibitors, and protein restriction alone has weaker support
than these pharmacological therapies for slowing CKD progression.[83]
Anemia – A target hemoglobin level of 100–120 g/L is recommended;[84][85] raising
hemoglobin levels to the normal range has not been found to be of benefit.[86]
Guidelines recommend treatment with parenteral iron prior to treatment
with erythropoietin.
Replacement of erythropoietin is often necessary in people with advanced
disease.[87]
It is unclear if androgens improve anemia.[88]
Calcitriol is recommended for vitamin D deficiency and control of metabolic bone
disease.
Phosphate binders are used to control the serum phosphate levels, which are
usually elevated in advanced chronic kidney disease.
Phosphodiesterase-5 inhibitors and zinc may improve sexual dysfunction in men.
[48]
Gadolinium based MRI contrast agents are contraindicated in those with GFR
less than 30 (stage 4 kidney disease) due to the risk of nephrogenic systemic
fibrosis. However, this risk is believed to be low in people with CKD, with newer
contrast agents being used.[27]
Other measures
[edit]
Aggressive treatment of high blood lipids is recommended.[79] Statins are
recommended for those with CKD older than 50 years old, and those younger if
certain other indications exist.[27]
Certain medications that are cleared from the body by the kidneys may need
dose adjustments or discontinuation in those with chronic kidney disease to
prevent accumulation of the medications in the body.[27]
Sodium-glucose cotransporter-2 (SGLT2) inhibitors are recommended by the
2024 KDIGO guideline to slow CKD progression in adults with eGFR ≥20
mL/min/1.73 m² who have type 2 diabetes, heart failure, or
significant albuminuria, with benefits seen regardless of diabetes status.[80] In the
DAPA-CKD trial, dapagliflozin reduced a composite of sustained eGFR decline,
end-stage kidney disease, or kidney or cardiovascular death compared with
placebo in patients with CKD with or without type 2 diabetes.[81] The EMPA-
KIDNEY trial reported a similar benefit for empagliflozin across a broader CKD
population, including patients without diabetes.[82]
The 2024 KDIGO guideline suggests a protein intake of approximately 0.8 g/kg
body weight per day in metabolically stable adults with CKD stages G3–G5, and
recommends avoiding high protein intake (>1.3 g/kg/d) in those at risk of
progression.[80] A more restrictive very-low-protein diet (0.3–0.4 g/kg/d)
supplemented with essential amino acids or ketoacid analogues may be
considered in selected patients at risk of kidney failure who are willing and able
to follow it, under close supervision; it is not appropriate for people who are
metabolically unstable, frail, sarcopenic, or undernourished, and is not
recommended for children due to growth concerns.[80] The earlier evidence base
for unsupplemented low-protein diets predates widespread use of RAS
inhibitors and SGLT2 inhibitors, and protein restriction alone has weaker support
than these pharmacological therapies for slowing CKD progression.[83]
Anemia – A target hemoglobin level of 100–120 g/L is recommended;[84][85] raising
hemoglobin levels to the normal range has not been found to be of benefit.[86]
Guidelines recommend treatment with parenteral iron prior to treatment
with erythropoietin.
Replacement of erythropoietin is often necessary in people with advanced
disease.[87]
It is unclear if androgens improve anemia.[88]
Calcitriol is recommended for vitamin D deficiency and control of metabolic bone
disease.
Phosphate binders are used to control the serum phosphate levels, which are
usually elevated in advanced chronic kidney disease.
Phosphodiesterase-5 inhibitors and zinc may improve sexual dysfunction in men.
[48]
Gadolinium based MRI contrast agents are contraindicated in those with GFR
less than 30 (stage 4 kidney disease) due to the risk of nephrogenic systemic
fibrosis. However, this risk is believed to be low in people with CKD, with newer
contrast agents being used.[27]
Other measures
[edit]
Aggressive treatment of high blood lipids is recommended.[79] Statins are
recommended for those with CKD older than 50 years old, and those younger if
certain other indications exist.[27]
Certain medications that are cleared from the body by the kidneys may need
dose adjustments or discontinuation in those with chronic kidney disease to
prevent accumulation of the medications in the body.[27]
Sodium-glucose cotransporter-2 (SGLT2) inhibitors are recommended by the
2024 KDIGO guideline to slow CKD progression in adults with eGFR ≥20
mL/min/1.73 m² who have type 2 diabetes, heart failure, or
significant albuminuria, with benefits seen regardless of diabetes status.[80] In the
DAPA-CKD trial, dapagliflozin reduced a composite of sustained eGFR decline,
end-stage kidney disease, or kidney or cardiovascular death compared with
placebo in patients with CKD with or without type 2 diabetes.[81] The EMPA-
KIDNEY trial reported a similar benefit for empagliflozin across a broader CKD
population, including patients without diabetes.[82]
The 2024 KDIGO guideline suggests a protein intake of approximately 0.8 g/kg
body weight per day in metabolically stable adults with CKD stages G3–G5, and
recommends avoiding high protein intake (>1.3 g/kg/d) in those at risk of
progression.[80] A more restrictive very-low-protein diet (0.3–0.4 g/kg/d)
supplemented with essential amino acids or ketoacid analogues may be
considered in selected patients at risk of kidney failure who are willing and able
to follow it, under close supervision; it is not appropriate for people who are
metabolically unstable, frail, sarcopenic, or undernourished, and is not
recommended for children due to growth concerns.[80] The earlier evidence base
for unsupplemented low-protein diets predates widespread use of RAS
inhibitors and SGLT2 inhibitors, and protein restriction alone has weaker support
than these pharmacological therapies for slowing CKD progression.[83]
Anemia – A target hemoglobin level of 100–120 g/L is recommended;[84][85] raising
hemoglobin levels to the normal range has not been found to be of benefit.[86]
Guidelines recommend treatment with parenteral iron prior to treatment
with erythropoietin.
Replacement of erythropoietin is often necessary in people with advanced
disease.[87]
It is unclear if androgens improve anemia.[88]
Calcitriol is recommended for vitamin D deficiency and control of metabolic bone
disease.
Phosphate binders are used to control the serum phosphate levels, which are
usually elevated in advanced chronic kidney disease.
Phosphodiesterase-5 inhibitors and zinc may improve sexual dysfunction in men.
[48]
Gadolinium based MRI contrast agents are contraindicated in those with GFR
less than 30 (stage 4 kidney disease) due to the risk of nephrogenic systemic
fibrosis. However, this risk is believed to be low in people with CKD, with newer
contrast agents being used.[27]