CKD Management

Implement Measures to Modify CV Risk Factors

• Lifestyle modification, smoking cessation.
• Lipid management for people with CKD (see KDIGO guidelines for further details):
  • If with diabetes, age ≥ 18 ➞ treat with a statin* , or
  • If without diabetes, age ≥ 50 ➞ treat with a statin*, or
  • If age ≥ 18 with known coronary artery disease, previous stroke, or 10-year Framingham risk > 10%➞ treat with a statin*
• For people with diabetes, target HbA1c to appropriate level using recommended therapies as per Diabetes Canada guidelines.
• HTN treatment targets for people with CKD (please refer to the 2018 Hypertension Canada Guidelines to ensure BP is measured appropriately):
  • If with diabetes, target BP < 130/80
  • If without diabetes, target BP < 120/90; consider a higher target (< 140/90) in frail individuals, long-term care residents, previous stroke, limited life expectancy (< 3 years), polypharmacy (> 5 meds), and standing systolic blood pressure (SBP) < 110
  • Use caution when treating systolic BP to target; risks may outweigh benefits when diastolic BP < 60

*Contraindications: active liver disease, high alcohol consumption or pregnancy. Women with childbearing potential should use a statin only if they are using reliable contraception.

Minimize Further Kidney Injury

• Avoid nephrotoxins such as non-steroidal anti-inflammatory drugs (NSAIDs), intravenous (IV) and intra-arterial contrast, etc. whenever possible (if eGFR < 60).
• Refer to the ORN medication safety list consisting of 41 commonly prescribed medications that should be avoided or dose adjusted (see Medication Safety List).
• If contrast necessary, consider oral hydration, withholding diuretics.
• Refer to Sick Day Medication List (see Evidence Summary (PDF)).

Implement Measures To Slow Rate of CKD Progression

• Repeat creatinine and potassium 2 weeks after initiation of angiotensin-converting-enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB) or diuretic use.
• If with diabetes and with ACR > 3, use an angiotensin-converting-enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) as first-line therapy. If BP already < 130/80, use ACEI or ARB cautiously, monitoring for signs and symptoms of hypotension.
• If without diabetes, ACR > 30 and BP not at target, use an ACEI or ARB as first-line therapy for HTN.