The evidence for the prevention of CKD is lacking as compared with large scale randomized trials for cardiovascular disease. Most trials have focused on modifiable diseases and risk factors that have been associated with CKD, namely diabetes and hypertension. Clinical evidence supports the recommendation for a goal HbA1c <7%, blood pressure target of <140/90 mmHg, tobacco cessation, and ideal body weight with BMI <27 to prevent the development of CKD. Due to the lack of widespread screening guidelines with serum creatinine or urinary albumin, often patients are diagnosed after CKD has developed.
Underlying risk factors associated with disease states should be treated, including optimization of glycemic control in diabetes and achievement of the goal blood pressure of <140/90 mmHg with ACE inhibitors or angiotensin-II receptor antagonists. Consideration can be given to a lower blood pressure goal in those with proteinuria of >500 mg per 24 hours. Although data are limited in the CKD population as compared with the general population, tobacco cessation, weight loss, salt restriction, and optimal lipid management with statin therapy are indicated. Moderate protein restriction is recommended in late stage (GFR category G4 or G5) disease, as a management strategy to control uremia in order to delay the initiation of dialysis. Severe protein restriction may result in malnourishment and poorer outcomes. Aspirin use has also been beneficial for cardioprotection in those with CKD, although there is a higher risk for minor bleeding than in the general population.
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