Slowing down CKD progression

How to effectively slow down the progress of chronic kidney disease?

Runólfur Pálsson, MD: Chronic kidney disease is a common medical problem and unfortunately it tends to be progressive. We do have some therapeutic options but not many.

We should focus on the underlying condition that is causing chronic kidney disease. If there is a treatable condition, some forms of glomerulonephritis, for instance, then we have to address that and treat the underlying disease in order to halt the progression of the disease.

In many cases we do not have a certain option, particularly in the elderly population. Chronic kidney disease is common in the elderly, where you have risk factors such as hypertension, diabetes, vascular disease, but we can have an impact there.

First of all, treating hypertension. We know that hypertension is important for the progression of chronic kidney disease. The target blood pressure is debated, but at least get it below 140/90 mm Hg and even further down using renin angiotensin blockers, like angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers, in patients with hypertension and proteinuria, whether it is due to diabetic nephropathy or other forms of glomerulopathies.

We also need to focus on glycemic control in those with diabetes, and I also believe that managing the risk factors of cardiovascular disease aiming for limiting the progression of atherosclerosis may be important. But chronic kidney disease does not only progress to kidney failure; actually it does in a minority of patients. It is even more important as a risk factor for cardiovascular disease, so we should also focus on that aspect.