与疾病状态相关的潜在危险因素也应予以治疗,包括优化糖尿病患者的血糖控制并使用 ACE 抑制剂和血管紧张素 II 受体拮抗剂实现目标血压值,即血压 <140/90 mmHg。对于尿蛋白 >500 mg/24 h 的患者来说,可考虑适当降低其血压的目标值。[67]James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014 Feb 5;311(5):507-20.
https://jamanetwork.com/journals/jama/fullarticle/1791497
http://www.ncbi.nlm.nih.gov/pubmed/24352797?tool=bestpractice.com
[134]Xie X, Atkins E, Lv J, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Lancet. 2016 Jan 30;387(10017):435-43.
http://www.ncbi.nlm.nih.gov/pubmed/26559744?tool=bestpractice.com
[68]Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 May 15;71(19):e127-248.
https://www.sciencedirect.com/science/article/pii/S0735109717415191?via%3Dihub
http://www.ncbi.nlm.nih.gov/pubmed/29146535?tool=bestpractice.com
[71]Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int Suppl. 2012 Dec;2(5):337-414.
https://kdigo.org/wp-content/uploads/2016/10/KDIGO-2012-Blood-Pressure-Guideline-English.pdf
尽管比起一般人群,在 CKD 人群中相关数据较为有限,但戒烟、减轻体重、限盐以及使用他汀类药物达到最佳血脂控制的方案仍适用。对于晚期(GFR 分类为 G4 或 G5)患者,建议中度限制蛋白摄入。这是一种控制尿毒症以推迟透析开始时间的管理策略。[109]Hahn D, Hodson EM, Fouque D. Low protein diets for non-diabetic adults with chronic kidney disease. Cochrane Database Syst Rev. 2018 Oct 4;(10):CD001892.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6517211/
http://www.ncbi.nlm.nih.gov/pubmed/30284724?tool=bestpractice.com
严重的蛋白摄入限制可能会引起营养不良并影响预后。阿司匹林在 CKD 患者当中可作为心血管保护剂而使患者受益,虽然相较于一般人群,CKD 人群使用阿司匹林会增加小出血的风险。