Which is the single best treatment for CKD?

Treatment

Which is the single best treatment for CKD?

Keep track of your kidney data with PKB
Keep your blood pressure (BP) normal, or low (130/80 maximum). This is the single best treatment for you.
Key points
  1. Normal/low blood pressure. That’s it. All the time. Other things you can do are:
  2. Lifestyle changes, and have ..
  3. CKD medication.

The above is true for most patients with CKD. 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. It varies from patient to patient.

Even though CKD is common (1 in 10 of the population), progression to kidney failure (Stage 5CKD) is 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.

So. Which is the single best treatment for CKD? (for most people)
1. Normal/low blood pressure. That’s it. All the time.

“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. CKD 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 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)

1. Other specific treatments
2. 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.

3. 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.

4. 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 which is the single best treatment for CKD. Normal or low blood pressure. Please discuss this and the other treatments above with your GP and kidney specialist (nephrologist) if you need to see one. We hope it has been helpful.

Other resources

7 treatments for CKD
Treatment for CKD
(longer articles)
Best treatments for early CKD (Saweirs, 2007)

 

 

 

 

 

Last Reviewed on 23 April 2024

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