Medical Management

Lifestyle Management

  • Exercise 30 minutes, 5 times per week
  • Achieve a healthy BMI (18.5 – 25)
  • Smoking cessation
  • Adequate fluid intake: Fluid restriction is not necessary for most patients.
  • Healthy diet: low sodium diet (2000 mg/day)
Download Sodium Food Handout (PDF)
  • Blood pressure targets:

    Diabetic: <130/80 mmHg

    Non diabetic: <140/90 mmHg

  • A1C target for patients with diabetes: < 7% eGFR info
Download Patient Tips for Managing CKD (PDF)
Drug Therapy
Prescribing Information
Diabetes No Diabetes
Prescribe an ACEi or ARB unless contraindicated. Prescribe an ACEi or ARB if ACR > 30 mg/mmol and no contraindications.

Dosage
Titrate to maximum tolerated dose.

Contra-
indications
  • Pregnancy
  • Women with childbearing potential should only use an ACEi or ARB if there is reliable contraception.

General
Information
  • Check potassium and eGFR within 2 weeks of starting or dose changes.
  • Combined therapy of ACEi and ARB not recommended.
  • ACEi or ARBs can cause a reversible reduction in eGFR when treatment is initiated (approximately 25%):
    • »  If the reduction in eGFR exceeds 25% below the baseline value, stop ACEi or ARB.
    • »  If the reduction in eGFR is 5 to 25%, re-check in 2-3 weeks to exclude further deterioration.
  • Increases in serum potassium of up to 0.5mmol/L can be expected with ACEi or ARB use.
Prescribing Information
Diabetes No Diabetes
Prescribe statin unless contraindicated. Age > 50: Prescribe statin unless contraindicated.
Age 18 – 49 : Prescribe statin if no contraindications and if any one of the following:

Dosage
Statin eGFR < 60 mL/min/1.73m2
Lovastatin Not studied
Fluvastatin 80 mg
Atorvastatin 20 mg
Rosuvastatin 10 mg
Simvastatin/Ezetmibe 20 mg/10 mg
Pravastatin 40 mg
Simvastatin 40 mg

Recommended doses (mg/d) of statins in adults with CKD


Contra-
indications
  • Active liver disease, high alcohol consumption or pregnancy.
  • Women with childbearing potential should only use statin if there is reliable contraception.

General
Information
  • No follow-up monitoring of lipid levels required unless the result will change course of therapy. Tooltip
  • Measure ALT prior to starting a statin. Follow-up monitoring not required as abnormalities are low in patients with normal baseline ALT.
  • CK not required at baseline or during follow-up unless patient develops symptoms suggestive of myopathy.
Prescribing Information
Diabetes No Diabetes
Low dose ASA (81mg) may be used for secondary prevention in patients with established vascular disease:
  • Acute coronary syndrome
  • Prior MI or coronary revascularization
  • Prior stroke or TIA
  • PVD (high risk patients with low bleeding risk).

Dosage
81 mg

Contra-
indications
  • History of ASA induced GI bleed.

General
Information
  • Low dose ASA for secondary prevention only.
Other Considerations