Chronic Kidney Disease: Management & Treatment Menu

Management of Chronic Kidney Disease

When filtration via the glomeruli and tubules (together, the “nephron” unit) declines with chronic kidney disease (CKD), the other nephrons compensate via “hyperfiltration.” While initially helpful, hyperfiltration ends up causing long-term damage and scarring in them, resulting in progressive kidney disease.

The gradual decline in kidney function in CKD is initially asymptomatic but is relentless toward end-stage renal disease (ESRD). Besides jeopardizing the kidney, it also increases the risk of cardiovascular disease from associated hypertension, diabetes, and a metabolic syndrome. Because of this, management and treatment of CKD is part of a combination management that includes heart health.

Management of CKD is focused on both treating symptoms and complications and on delay in progression.

Treatment of reversible causes:

  • Hypovolemia/decreased renal perfusion, from vomiting, diarrhea, hypotension, and diuretics.
  • Elimination of nephrotoxic drugs (certain antibiotics, GI acid reducers, or antifungal agents).
  • Urinary tract obstruction, addressed by dissolution, retrieval, or passage of a stone.

Treatment of reversible consequences:

  • Acidosis can be mitigated by sodium bicarbonate therapy to prevent its consequences (CKD progression, bone deterioration, and malnutrition). Such “alkali” therapy slows progression of CKD
  • Treatment for hypertension (in its vicious cycle with CKD) with antihypertensive medication, weight management, and smoking cessation
  • Treatment of dyslipidemia (cholesterol/triglyceride elevations) with statin drugs
  • Reduction of proteinuria/albuminuria (excreting protein/albumin in the urine), with ACE inhibitors or angiotensin receptor blockers; protein restriction
  • Glycemic control and maintenance of a target hemoglobin A1c level, which can slow albuminuria

Treatment of complications of CKD:

  • Electrolyte imbalance (potassium, calcium, phosphate, sodium, etc.)
  • Hypertension
  • Anemia from iron, vitamin B12, or folate deficiency
  • Dyslipidemia (abnormal lipid–cholesterol/triglycerides)
  • Pericarditis and pericardial effusions
  • Neuropathy (cognitive changes related to uremia)
  • Hypothyroidism from impaired excretion of thyroid hormones
  • Prevention of infection (immunizations), as the general debilitation from CKD makes one prone to communicable diseases

End-Stage Renal Failure (ESRF)

With progressive failure, the dysfunction in CKD can eventually reach “end-stage renal failure” (ESRF), treated with either dialysis or kidney transplant, or dialysis while awaiting kidney transplant.


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This information is provided by Vascular Health Clinics and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition.

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