CKD Mangement

This article can help in understanding some general issues and the management of Chronic Kidney Disease:


  • It is important to understand that CKD is a spectrum of disease. Mild CKD is common and rarely progresses to a more severe form and it does not necessarily equate to renal dialysis.
  • Understand eGFR and monitor it on a regular basis to ensure that the condition is not deteriorating.
  • Understand the link between diabetes and hypertension – maintaining a tight control can limit the damage of the kidneys.
  • People with CKD should exercise, achieve a healthy weight and must stop smoking.
  • A good glycaemic control should be achieved in patients with diabetes mellitus and CKD.
  • Review all prescribed medicines regularly.

Already Diagnosed: eGFR is less than 60

  • Review GFR and assess the rate of deterioration.
  • Review all medication including the over-the-counter drugs.
  • Haematuria and proteinuria suggest glomerulonephritis, this may progress rapidly.
  • Look for sepsis, heart failure, hypovolaemia, palpable bladder.
  • Repeat serum creatinine measurement to exclude rapid progression.
  • Seek professional help – there are safe and natural options to address this disease.


  • Based on the severity of the disease, eGFR should be monitored regularly.
  • Have the level of proteinuria assessed at least annually.
  • Proteinuria should be assessed by measurement either of the PCR or ACR, ideally on an early-morning urine specimen.
  • An abnormal eGFR should prompt a clinical assessment and a repeat test within two weeks should be done to assess the progression.
  • Patient with CKD should have an annual assessment of their cardiovascular risk factors, lipid profile, BMI, exercise, alcohol and smoking habits.
  • Keep the systolic blood pressure below 140mm Hg and the diastolic blood pressure below 90mm Hg.
  • Routinely measure calcium, phosphate, parathyroid hormone (PTH) and vitamin D levels.
  • Renal dietitian should be consulted to carry out a dietary assessment and give individualized information and advice on diet.


  •  Anemia: left ventricular hypertrophy, fatigue, impaired cognitive functioning.
  •  Coagulopathy.
  • Hypertension: left ventricular hypertrophy, heart failure, stroke, CVD.
  • Calcium phosphate loading: cardiovascular and cerebrovascular disease, arthropathy, soft tissue calcification.
  • Renal osteodystrophy: disorders of calcium, phosphorus and bone, most commonly osteitis fibrosa cystica.
  • Bone changes of secondary hyperparathyroidism: bone pain and fractures.
  • Neurological: uraemic encephalopathy, neuropathy including peripheral neuropathy.
  • Dialysis amyloid: bone pain, arthropathy, carpal tunnel syndrome.
  • Fluid overload: pulmonary oedema, hypertension
  • Malnutrition: increased morbidity and mortality, infections, poor wound healing.
  • Glucose intolerance due to peripheral insulin resistance.

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Results may vary from patient to patient.