First-Line Treatment of Chronic Kidney Disease: Comprehensive Risk-Modification Strategy
This first-line protocol addresses adults with chronic kidney disease through a comprehensive treatment and risk-modification strategy that integrates multiple lifestyle interventions alongside targeted pharmacological therapy.
Treatment Approach
The regimen pairs structured lifestyle modification — covering moderate-intensity physical activity, dietary quality (emphasising plant-based foods and limiting ultraprocessed foods), protein and sodium intake, and tobacco avoidance — with specific pharmacological agents whose eligibility is defined by kidney function parameters and albuminuria. The complete selection criteria, agents, and management algorithm are in the full protocol.
Primary Clinical Target
Blood pressure: Target systolic blood pressure <120 mm Hg when tolerated, using standardized office blood pressure measurement.
References
DOI: 10.1016/j.kint.2023.10.018
- We recommend that people with CKD be advised to undertake moderate-intensity physical activity for a cumulative duration of at least 150 minutes per week, or to a level compatible with their cardiovascular and physical tolerance (1D).
- Advise people with CKD to adopt healthy and diverse diets with a higher consumption of plant-based foods compared to animal-based foods and a lower consumption of ultraprocessed foods.
- We suggest maintaining a protein intake of 0.8 g/kg body weight/d in adults with CKD G3–G5 (2C).
- We suggest that sodium intake be <2 g of sodium per day (or <90 mmol of sodium per day, or <5 g of sodium chloride per day) in people with CKD (2C).
- Encourage people with CKD to undertake physical activity compatible with cardiovascular health, tolerance, and level of frailty; achieve an optimal body mass index (BMI); and not to use tobacco products.
- We suggest that adults with high BP and CKD be treated with a target systolic blood pressure (SBP) of <120 mm Hg, when tolerated, using standardized office BP measurement (2B).