Management of Patients with Chronic Kidney Disease

Management of Patients with Chronic Kidney Disease

Chronic kidney disease is a damaged kidney or a decreased glomerular filtration rate; it includes all levels of decreased kidney function. A decrease in kidney function is either mild, moderate, or severe. Notably, the elderly are more affected by chronic kidney diseases than younger patients. Nonetheless, chronic kidney disease is a global problem with high prevalence and incidence, hence the need for proper treatment and management (Kovesdy, 2022). Adequate treatment and management reduce the risk of end-stage renal disease and cardiovascular disease. An early diagnosis, treatment, and management are crucial for preventing chronic kidney disease and treating the underlying disorder. Treatment and management of chronic kidney disease aim to prevent disease progression, slow disease progression, treat the underlying disorder, and provide long-term renal replacement therapy (Vaidya & Aeddula, 2022).

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Management of chronic kidney disease focuses on stopping or slowing disease progression through blood pressure control, treatment of underlying causes, blood glucose level control, treatment of hyperlipidemia, and avoiding nephrotoxins (Vaidya & Aeddula, 2022). To prevent nephrotoxicity, NSAIDs, aminoglycosides, and other nephrotoxic drugs are controlled in chronic disease patients. Thyroid hormone replacement therapy using L-thyroxine prevents and slows progression to end-stage renal disease. Angiotensin receptor blockers such as losartan are prescribed for diabetic kidney disease and proteinuria to control blood pressure. Angiotensin-converting enzyme inhibitors are prescribed in proteinuria.

Pathologic manifestations of chronic kidney disease include anemia, hyperparathyroidism, metabolic acidosis, volume overload, uremic manifestations, growth failure in children, hyperphosphatemia, cardiovascular complications, and hypocalcemia (Vaidya & Aeddula, 2022). Patients with non-hemodialysis dependent chronic kidney disease with a hemoglobin A1c of more than 9% lead to worse clinical outcomes, while patients with lower HbA1c levels have higher mortality rates. Anemia is treated using erythropoietin to ensure a hemoglobin level of 10 to 12 g/dL, ferritin at 200 to 500 ng/mL, and an iron saturation of 30% to 50%. Patients with chronic kidney disease and diabetes mellitus require intensive control of blood glucose levels and HbA1c levels. Hyperphosphatemia, hypocalcemia, and hyperparathyroidism are mineral and bone disorders that are pathologic manifestations of chronic kidney disease. Treatment aims to decrease phosphorus levels, prevent osteoporosis, decrease parathyroid hormone levels, and maintain calcium levels. Hyperphosphatemia is treated using dietary changes and phosphate binders. Dietary adjustments aim to restrict dietary phosphate intake in chronic kidney disease patients. Phosphate binders such as calcium acetate decrease phosphorus levels. Hypocalcemia is treated using calcitriol and calcium supplements, while hyperparathyroidism is treated using vitamin D analogs and calcitriol.

Metabolic acidosis is a pathologic manifestation of chronic kidney disease. Treatment and management of metabolic acidosis impact bone metabolism and protein in chronic kidney disease patients. Patients are managed using alkali therapy to ensure the serum bicarbonate concentration is higher than 22 mEq/L. Bicarbonate supplementation of about 6g/day slows the decline of renal function and the progression of chronic kidney disease (Vaidya & Aeddula, 2022). Cardiovascular complications are a pathologic manifestation of chronic kidney disease. Cardiovascular complications are prevented and treated using statins and non-vitamin K oral anticoagulants (NOACs). Patients with a GFR lower than 60Ml/min/1.73m who are not on kidney transplant or long-term dialysis are treated with statins and ezetimibe. Statins and ezetimibe are patients on long-term dialysis for chronic kidney disease. Patients already on statin therapy before dialysis should continue with their statins during dialysis. Statins lower the risk of coronary events. NOACs are indicated for venous thromboembolism, atrial fibrillation, and dialysis access thrombosis prophylaxis.

Treatment and management of chronic kidney disease focus on renal replacement therapy. Patients who require renal replacement therapy mainly present with encephalopathy, severe metabolic acidosis, pericarditis, hyperkalemia, peripheral neuropathy, intractable volume overload, intractable gastrointestinal symptoms, growth failure, and malnutrition (Vaidya & Aeddula, 2022). Asymptomatic adults with a GFR of 5 to 9 Ml/min/1.73 m are scheduled for renal replacement t