Therapeutic Considerations in Preventing Chronic Kidney Disease

Chronic kidney disease (CKD) affects 35.5 million US adults, but most patients are unaware of their diagnosis. Screening for CKD at-risk individuals is required, as symptoms do not appear until advanced stages. The combination of urine albumin-to-creatinine ratio and estimated glomerular filtration rate permits the classification of CKD stages and the determination of risk of CKD progression and cardiovascular disease, which is the most common cause of death in CKD. Cardiovascular-kidney-metabolic syndrome highlights the complex interplay between the heart, kidney, and metabolic disorders, such as diabetes and dysfunctional obesity, which promotes chronic inflammation, leading to injury in these organs and systems. New guideline-directed medical therapies consisting of sodium-glucose cotransporter 2 inhibitors, glucose-like peptide-1 receptor agonists, and nonsteroidal mineralocorticoid receptor antagonists, in addition to standard-of-care therapies including angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, have revolutionized CKD management, which may be best facilitated through a multidisciplinary care approach.