n CME : Your SA Journal of CPD - Predialytic treatment of chronic kidney disease : main article



  • Progression of renal function deterioration occurs in the majority of patients with CKD.
  • The progression can be slowed by paying particular attention to blood pressure control and, additionally in diabetic nephropathy, tight control of blood sugar.
  • Obesity and smoking are deleterious factors in progression and must be handled from the outset.
  • Salt retention is always a problem with the diseased kidney and therefore salt restriction and a diuretic are useful in alleviating fluid retention and controlling the blood pressure.
  • ACE-I and / or ARB treatment is essential in any patient with CKD with proteinuria and / or hypertension. They have a positive influence in slowing renal function deterioration.
  • NSAIDs inhibit diuretic action.
  • Spironolactone is being suggested for use in patients with CKD accomplishing total RAAS block. The evidence of efficacy in slowing progression and reducing proteinuria is encouraging but not substantial. Judgement on the safe use of this agent is still awaited.
  • Reduction of phosphate levels is essential for the bone well-being of the patient with CKD. The only way we in SA can achieve this is with the use of calcium carbonate given before meals.
  • The new osteodystrophy classification relies on states of bone turnover together with mineralisation status and bone volume.
  • Lipid-lowering agents should be prescribed in patients with CKD (insulin-resistant state) although the efficacy in slowing progression has not yet been established. This is particularly pertinent in patients with the nephrotic syndrome.


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