Primary prevention

Your Organisational Guidance

ebpracticenet urges you to prioritise the following organisational guidance:

Chronisch nierlijden (multidisciplinaire aanpak)Published by: WORELLast published: 2017GPC pluridisciplinaire sur la néphropathie chronique (IRC)Published by: Groupe de travail Développement de recommandations de première ligneLast published: 2017

Modifiable lifestyle factors consistently predict the incidence of chronic kidney disease (CKD).[47]​ Evidence for prevention is, however, limited.

A goal HbA1c <53 mmol/mol (<7%), blood pressure (BP) target of <140/90 mmHg, tobacco cessation, and ideal body weight with BMI <27 is recommended to prevent the development of CKD.​​[30][34]​​​​​[48]

Secondary prevention

Prevention of further kidney function loss is the primary goal of conservative management of people with CKD.[60] Kidney-preserving care includes non-pharmacological (e.g., dietary and lifestyle adjustments) and pharmacological strategies.[60]

Protein restriction is recommended in late-stage (GFR category G4 or G5) disease to delay the initiation of dialysis; however, severe protein restriction may result in malnourishment and impact on quality of life.[171]

Patients with comorbidity

Underlying risk factors associated with disease states should be treated, including optimising BP and glycaemic control in diabetes to individualised targets.[1]​ Tobacco cessation, weight loss, salt restriction, and optimal lipid management with statin therapy are indicated. Use of low-dose aspirin is recommended for secondary prevention (of cardiovascular disease events) in patients with CKD and ischaemic cardiovascular disease.[1] There is a higher risk for minor bleeding than in the general population.

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