Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Management of a patient with stage 3 chronic kidney disease (CKD) involves:
- Arranging regular follow-up in primary care, with frequency based on clinical judgement and risk factors for progression.
- Assessing and managing underlying causes of CKD and reversible risk factors to slow disease progression.
- Reviewing and avoiding potentially nephrotoxic drugs, especially NSAIDs, and advising on their discontinuation during acute illness with clear instructions on when to restart.
- Monitoring kidney function (eGFR) and albuminuria (urinary albumin:creatinine ratio, ACR) to assess disease progression and cardiovascular risk.
- Managing hypertension according to ACR levels: if ACR is ≤30 mg/mmol, treat hypertension as in adults without CKD; if ACR >30 mg/mmol, offer an ACE inhibitor or ARB titrated to the highest tolerated dose, avoiding combination renin-angiotensin system antagonists.
- Aiming for blood pressure targets: systolic <140 mmHg and diastolic <90 mmHg if ACR <70 mg/mmol; systolic <130 mmHg and diastolic <80 mmHg if ACR ≥70 mg/mmol.
- Providing lifestyle advice including maintaining a healthy weight, regular exercise, smoking cessation, and a healthy diet.
- Offering dietary advice tailored to CKD severity on potassium, phosphate, calorie, and salt intake, with specialist dietitian referral if needed.
- Advising against routine low-protein diets but maintaining protein intake around 0.8 g/kg/day and avoiding high protein intake.
- Providing education and information to the patient and carers about CKD, its progression, treatment options, and self-management strategies.
- Assessing and managing associated anxiety or depression and cardiovascular disease risk appropriately.
- Referring to nephrology if hypertension remains uncontrolled despite four antihypertensive drugs or if there is accelerated progression or other complications.
These steps aim to slow CKD progression, reduce complications, and prepare for potential advanced care if needed 1,2,3.