Multifaceted interventions aimed at numerous risk factors may reduce the risk of all-cause mortality and the risk of progression to end-stage kidney failure in patients with CKD. In the Modification of Diet in Renal Disease (MDRD) Study, dietary protein restriction (0.58 g/kg/day) vs a usual protein diet (1.3 g/kg/day) did not significantly affect the mean change in GFR over 3 years. However, secondary analyses suggested that a low-protein diet may slow the GFR decline in patients with the most rapidly declining GFR. The nutritional status of all patients who are started on protein restriction should be monitored.
Some studies have shown that the time of day at which patients take antihypertensive medications can affect circadian patterns of blood pressure, which may translate into an effect on clinical outcome.
ACEIs as well as angiotensin receptor blockers can be used in patients with CKD as tolerated; however, this should be accompanied by close monitoring for renal deterioration and for hyperkalemia, including monitoring of serum creatinine levels with every dose change.
Soaking foods in water and boiling them can reduce the dietary phosphorus content per gram of protein in foods without affecting protein content, which can be beneficial for patients with hyperphosphatemia. For example, boiling sliced meat for 30 minutes has been shown to reduce phosphate content by 50%, with no significant changes in the protein content.
Learn more about the management of CKD.
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Cite this: A. Brent Alper. Fast Five Quiz: Chronic Kidney Disease (CKD) Management - Medscape - Apr 22, 2021.