Treatment of chronic kidney disease (CKD) can slow its progression to
end-stage renal disease (ESRD).
Treatment of chronic kidney disease (CKD) aims to slow progression to
end-stage renal disease (ESRD) and to prepare for ESRD.
Control hypertension (high blood pressure)—Target systolic blood pressure
(BP) is 120 to 135 mm Hg; target diastolic BP is 70 to 80 mm Hg.
Antihypertensive medication from the ACE class is preferable because of
protective effects on the kidneys.
Restrict dietary protein—Dietary protein is broken down into amino acids and
absorbed from the stomach into the blood. The amino acids are taken from the
bloodstream and used to build muscle and perform other essential functions.
Excess amino acids are further broken down into carbohydrates and
nitrogen-containing waste that is eliminated by the kidneys. Amino acid disposal
further burdens the kidneys, and is believed to speed the progression of CRF.
This process is like forcing a damaged machine to work harder, causing it to
break down sooner than expected.
Affected patients must be cautious not to overdo protein restriction, because
it can lead to malnutrition and muscle wasting. Moderate protein restriction for
a CRF patient is about 0.6 to 0.8 gm/kg/day, which is effectively achieved by
following the advice of a dietician.
Manage pre-end-stage renal disease (pre-ESRD)—Treatment for pre-ESRD should
begin once the glomerular filtration rate (GFR) falls below 30 milliliters per
minute (< 30 mL/min). Pre-ESRD management includes the identification and
treatment of anemia (low red blood cell count). When the GFR drops below 30
mL/min, anemia often develops because the kidneys produce an inadequate amount
of erythropoetin (EPO). This hormone is made by the kidneys and travels to the
bone marrow, where it stimulates red blood cell production. Anemic patients are
candidates for EPO (Procrit®) injections to maintain their hematocrit (volume
percent of red blood cells in whole blood) between 30% and 36%.
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