Fast Five Quiz: Is Your Knowledge of Chronic Kidney Disease Sufficient?

Vecihi Batuman, MD

Disclosures

April 20, 2018

Measures indicated to delay or halt the progression of CKD include the following:

  • Treatment of the underlying condition if possible

  • Aggressive blood pressure control to target values per current guidelines, including reducing dietary intake of sodium to < 2000 mg/dL

  • Treatment of hyperlipidemia to target levels per current guidelines (although the efficacy of statin drugs has not been confirmed in patients with advanced CKD)

  • Aggressive glycemic control per the American Diabetes Association (ADA) recommendations (target hemoglobin A1c [HbA1C] < 7%)

  • Avoidance of nephrotoxins, including intravenous radiocontrast media, NSAIDs, and aminoglycosides

  • Use of renin-angiotensin system blockers among patients with diabetic kidney disease and proteinuria

  • Use of ACE inhibitors or ARBs in patients with proteinuria

Aggressive blood pressure control can help to delay the decline in renal function in patients with CKD. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII) and KDOQI suggest a target blood pressure of < 130/80 mm Hg. Systolic blood pressure control is considered more important than diastolic blood pressure control. However, systolic blood pressure is also considered difficult to control in elderly patients with CKD.

Data support the use of ACE inhibitors or ARBs in diabetic kidney disease with or without proteinuria. In nondiabetic kidney disease, these agents are effective in retarding the progression of disease among patients with proteinuria of more than 500 mg/dL.

Paricalcitol (Zemplar®), a synthetic vitamin D analogue, is approved by the US Food and Drug Administration (FDA) for the prevention and treatment of secondary hyperparathyroidism associated with CKD stage 5. However, a meta-analysis has found that paricalcitol also can safely reduce protein excretion in patients with CKD stages 2-5. Whether paricalcitol can slow the development of ESRD or reduce mortality is not yet known.

For more on delaying or halting CKD, read here.

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