7 treatments for CKD

7 treatments for CKD

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Key points

1. Normal/low blood pressure. That’s it. All the time
2. Lifestyle changes
3. CKD medication.

The above is true for most patients. The information below is largely for people with advanced CKD (CKD4-5)

1. Other specific treatments – e.g. a urinary catheter (tube into the bladder) in obstructive nephropathy; or drugs to suppress the immune system – in some types of vasculitis and chronic glomerulonephritis 
2. Dialysis
3. Kidney transplant
4. See a kidney specialist (nephrologist).

Whilst CKD is not curable, it can be managed effectively to slow its progression and control symptoms. The treatment approach depends on the stage of the disease and the underlying cause.

Even though CKD is common (1 in 10 of the population), progression to kidney failure (Stage 5CKD) is fortunately rare and only occurs in 1 in 100 of patients with CKD, i.e. 1 in 1000 of the population. This means each GP will have 2 patients ‘on their books’ on dialysis or with a kidney transplant.

But we will now describe 7 treatments for CKD (for most patients).

1. Normal/low blood pressure

“The one thing that all patients with CKD should strive for is normal (or better low) blood pressure = of<130/80 at all times, and <120/70 if you have diabetes. This will slow the progression of all causes of CKD”

2. Lifestyle changes

This includes keeping your weight down (if overweight), regular exercise, quitting smoking, and limiting alcohol intake. These changes can help manage CKD and may slow its progression.

3. Medication

Many medications help CKD:

• ACE/ARBs (blood pressure tablets). Apart from patients with renovascular disease, these tablets benefit most patients with CKD and slow its progression
• SGLT2is (originally for diabetes). These also lower blood pressure and slow the progression of CKD. They benefit patients with or without diabetes. Most patients with CKD should be considered for SGLT2is and ACE/ARBs, usually in combination
• Other drugs. These may include other drugs to lower blood pressure, control blood glucose levels (in diabetes), lower cholesterol levels, treat anaemia (EPO), and protect the bones (calcium and vitamin D).

The above is true for most patients. The information below is largely for people with advanced CKD (CKD4-5)

4. Other specific treatments

• Urinary catheter (tube into the bladder) in obstructive nephropathy, or
• Drugs to suppress the immune system – in vasculitis and some types of chronic glomerulonephritis (autoimmune diseases of the glomerulus).

5. Dialysis

This treatment, required for the advanced CKD (CKD5 or kidney failure), is a treatment to replicate the kidney’s filtration function. It does not treat the underlying disease. There are two types: peritoneal and haemodialysis. Both provide about 5% of normal kidney filtration function.

6. Kidney transplant

This is a surgical procedure where a healthy kidney from a donor is transplanted into a person with CKD. It is also a treatment to replicate the kidney’s filtration function. Like dialysis, it does not treat the underlying disease.

It’s often the most effective treatment for kidney failure (also called ESRF, end-stage renal failure).

7. Kidney specialist (nephrologist)

If you have Stage 3B CKD or worse you should see or be discussed with a nephrologist. If referred, do not allow yourself to be discharged unless your CKD is stable and there is little/no likelihood of progression to dialysis or a kidney transplant.

Summary

We have described 7 treatments for CKD. Please discuss them with your GP and kidney specialist (nephrologist) if you need to see one. We hope it has been helpful.

Other resource

Treatment for CKD (longer article)
Single best treatment for CKD

Last Reviewed on 7 May 2024