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Preface and Contents

Chronic Kidney Disease : Treatment

Importance and Goals

The three treatment options for CKD are medical management, dialysis or transplant.

  • All patients with CKD are treated initially by medical management (medicine, dietary advice and monitoring).
  • Severe damage in CKD (ESKD) requires kidney replacement by dialysis or transplant.

Medical Management

Why is medical management very important in CKD?

There is no cure for CKD. Advanced CKD needs dialysis or kidney transplant to maintain life. Because of the high cost and problems of availability, in India only 5 -10% of kidney patients get treatment like dialysis and kidney transplant, while the rest die without getting any definitive therapy. Therefore, early detection and meticulous conservative medical management is the only feasible and less expensive way to manage CKD and delay the need for dialysis or transplant.

Initiation of proper therapy at early stages of CKD is most rewarding. Most patients are asymptomatic or feel very well with proper therapy in early stages. Because of the absence of symptoms many patients and their families fail to recognize the seriousness of the disease and discontinue medicine and dietary restrictions. Discontinuation of therapy may lead to rapid worsening of kidney function requiring expensive dialysis or kidney transplantation.

In CKD with early medical management patients can live a long life.

In CKD with early medical management patients can live a long life.

What are the goals of medical management in CKD?

CKD is a progressively deteriorating condition with no cure. The aims of medical management are to:

  1. Slow down the progression of the disease.
  2. Treat underlying causes and contributing factors.
  3. Relieve symptoms and treat complications of the disease.
  4. Reduce the risk of developing cardiovascular disease.
  5. Delay the need for dialysis or transplant.

What are the treatment strategies in different stages of CKD?

Treatment strategies and recommended actions in different stages of chronic kidney disease are summarized in this table.

Stage Recommended Action
All Stages
  • Regular follow up and monitoring
  • Life style changes and general measures:
  • Diagnose/treat to slow down the progression
  • Educate patients on disease management
  • Treat comorbid conditions, cardiovascular disease risk reduction
  • Estimate progression; treat co-morbid conditions
  • Evaluate/treat complications; refer to nephrologist
  • Educate patients on kidney replacement options Prepare for kidney replacement therapy
  • Kidney replacement by dialysis or transplant
Chronic kidney disease is not curable, but early treatment is most rewarding.