Chapter

Management of chronic kidney disease: controlling hypertension and reducing proteinuria

Aimun Ahmed, Fairol H. Ibrahim and Meguid El Nahas

in Chronic Kidney Disease

Published on behalf of Oxford University Press

Published in print December 2009 | ISBN: 9780199549313
Published online February 2013 | e-ISBN: 9780191763465 | DOI: http://dx.doi.org/10.1093/med/9780199549313.003.0008

Series: Oxford Clinical Nephrology Series

Management of chronic kidney disease: controlling hypertension and reducing proteinuria

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In conclusion, the management of hypertension in CKD depends on the renal and cardiovascular risk profile of the patient. Patients with low renal and cardiovascular risks, namely those with CKD stages 1 and 2 and no or mild proteinuria (<1g/24h), could be treated according to guidelines set by national and international hypertension societies. On the other hand, those with more advanced renal insufficiency (CKD stages 3–5) and/or those with proteinuria who are at high renal and CVD risks should be treated according to the K/DOQI and NICE guidelines for the management of hypertension in CKD with lower treatment and target thresholds <130/80mmHg (Levey & Uhlig, 2006). The great majority of these patients will require more than one agent to control their BP down to recommended target levels <130/80mmHg. Compliance is often a problem, and so the conventional stepped care approach to the management of hypertension may not be optimal to minimize side effects and improve compliance. Combination therapy of two or three drugs at lower doses may be a better initial option.

Hypertension is the single, most important, modifiable risk factor to prevent the onset and progression of CKD. Its detection and management are the cornerstones of the detection and management of CKD.

It is very important when treating hypertension in CKD to take into consideration the detection and management of all the modifiable factors associated with hypertension such as proteinuria, hyperglycaemia (in diabetes), obesity, dyslipidaemia, and smoking. It is expected that such a multifactorial approach to the management of progressive CKD will not only slow the decline of kidney function, or even halt it, but also minimize the CVD morbidity and mortality associated with CKD.

Chapter.  6763 words.  Illustrated.

Subjects: Nephrology

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