Kidney Int. KDIGO clinical practice guideline for the management of blood pressure in chronic kidney disease. Zelniker TA, Wiviott SD, Raz I, et al. Wilhelm-Leen ER, Winkelmayer WC. Experience with GLP-1 agonists in patients with renal dysfunction is limited; therefore, these agents should be used with caution. Treatment recommendations are specific to patient groups: see disclaimer, 1st line – ACE inhibitor or angiotensin-II receptor antagonist, lisinopril: 2.5 to 5 mg orally once daily initially, adjust dose gradually according to response, maximum dose depends on level of impairment, ramipril: 1.25 mg orally once daily initially, adjust dose gradually according to response, maximum dose depends on level of impairment, enalapril: 2.5 mg orally once daily initially, adjust dose gradually according to response, maximum dose depends on level of impairment, perindopril erbumine: 2 mg orally once daily initially, adjust dose gradually according to response, maximum dose depends on level of impairment, trandolapril: 0.5 mg orally once daily initially, adjust dose gradually according to response, maximum dose depends on level of impairment, captopril: 12.5 to 25 mg orally two to three times daily initially, adjust dose gradually according to response, maximum dose depends on level of impairment, losartan: 50 mg orally once daily initially, adjust dose gradually according to response, maximum 100 mg/day, irbesartan: 75 mg orally once daily initially, adjust dose gradually according to response, maximum 300 mg/day, telmisartan: 20 mg orally once daily initially, adjust dose gradually according to response, maximum 80 mg/day, eprosartan: 300 mg orally once daily initially, adjust dose gradually according to response, maximum 600 mg/day, The 2014 Joint National Committee 8 redefined the target blood pressure (BP) goal for patients with CKD as <140/90 mmHg, given the evidence from clinical trials that this is associated with the lowest risk of cardiovascular outcomes and mortality. http://www.ncbi.nlm.nih.gov/pubmed/24458078?tool=bestpractice.com Lancet. Kidney Int. Your feedback has been submitted successfully. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. Kidney Int Suppl. Kidney Int. http://www.ncbi.nlm.nih.gov/pubmed/30665953?tool=bestpractice.com http://www.ncbi.nlm.nih.gov/pubmed/17108343?tool=bestpractice.com The algorithms will be updated periodically but changes in national practice may occur more quicklyusers are advised to stay abreast of current clinical practice recommendations. http://www.ncbi.nlm.nih.gov/pubmed/29735306?tool=bestpractice.com Yusuf S, Teo KK, Pogue J, et al; ONTARGET Investigators. 2008 Apr 10;358(15):1547-59. http://www.ncbi.nlm.nih.gov/pubmed/31857443?tool=bestpractice.com Diabetes Care. The Kidney Disease: Improving Global Outcomes (KDIGO) 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (CKD) serves to update the 2002 KDOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification following a decade of focused research and clinical practice in CKD. Pfeffer MA, Burdmann EA, Chen CY, et al. However, HbA1c 7.0% to 7.9% may be more appropriate in some patients, such as those with advanced age, limited life expectancy, known cardiovascular disease, high risk of severe hypoglycemia, or difficulty achieving lower HbA1c goals despite the use of multiple antihyperglycemic medications and insulin. N Engl J Med. N Engl J Med. http://www.ncbi.nlm.nih.gov/pubmed/29735306?tool=bestpractice.com Kidney Int Suppl. Standards of medical care in diabetes - 2020. https://kdigo.org/wp-content/uploads/2017/02/2017-KDIGO-CKD-MBD-GL-Update.pdf Sodium-glucose cotransporter 2 inhibition and diabetic kidney disease. ACE inhibitors and angiotensin-II receptor antagonists are the superior treatment for patients with CKD. Drüeke TB, Locatelli F, Clyne N, et al; CREATE Investigators. Aliskiren is not recommended for use in combination with ACE inhibitors or angiotensin-II receptor antagonists. Circulation. For patients with GFR category G5 CKD on dialysis, calcium, phosphorus, and intact parathyroid hormone (PTH) levels should be managed with phosphate binding agents, calcimimetics, active vitamin D analogs, or a combination of these based on serial laboratory assessments. 2018 May 15;71(19):e127-248. Renoprotective effects of sodium-glucose cotransporter-2 inhibitors. Buse JB, Wexler DJ, Tsapas A, et al. SGLT2 inhibitors, in addition to reducing hyperglycemia, have renal benefits through independent effects on renal tubular glucose reabsorption, weight, blood pressure, intraglomerular pressure, albuminuria, and slowed GFR loss. Comparison of the effects of glucagon-like peptide receptor agonists and sodium-glucose cotransporter 2 inhibitors for prevention of major adverse cardiovascular and renal outcomes in Type 2 diabetes mellitus. The Kidney Disease: Improving Global Outcomes guidelines recommend a BP goal of ≤130/80 mmHg if urinary albumin excretion is ≥30 mg/24 hours in patients with and without diabetes. Peginesatide was withdrawn from the market in early 2013 due to postmarketing reports of serious and fatal hypersensitivity reactions. Curr Opin Nephrol Hypertens. Mild diuretic therapy with loop and thiazide diuretics should be used for treating ankle oedema only after assessment of volume status has occurred. N Engl J Med. 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