CKD is mostly progressive and leads to end-stage renal disease (ESRD) and the need for renal replacement therapy (i.e., dialysis, transplant). Though it cannot be cured, it can be controlled and managed to a large extent. CKD is a strong cardiovascular risk factor, and the majority of patients with CKD will die prior to reaching ESRD. As kidney function declines, complications such as anemia and hyperparathyroidism develop that may contribute to worsening cardiovascular disease and renal osteodystrophy, respectively. Glycemic control directly correlates with the development of diabetic nephropathy and the rapidity of progression to end-stage renal disease. There is evidence that the use of SGLT2 inhibitors prevents major kidney outcomes (e.g., dialysis, transplantation, or death due to kidney disease) in people with type 2 diabetes. Optimization of blood pressure control with the use of ACE inhibitors or angiotensin-II receptor antagonist agents and reduction in proteinuria may slow the rate of progression to ESRD and the eventual need for renal replacement therapy.
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