[38] With regard to blood pressure management new evidence reviewed in this updated guideline has led to an upward revision
of the recommended BP targets. These new targets are in line with those recommended by the NHMRC.[39] There are a number of epidemiological studies[40, 41] which have established that asymptomatic hyperuricaemia is associated with both CKD and ESKD. However, hyperuricaemia is a ubiquitous finding find more in CKD[42] and could be a consequence of reduced excretion, diuretic therapy, or oxidative stress. Although it is not clear whether urate plays a causative role or is an indirect marker of kidney function, uric acid lowering therapy has emerged as a potentially novel therapeutic treatment for slowing the progression of CKD.[41] In the CKD population, both vitamin D deficiency and insufficiency are common. As GFR falls, hydroxylation/activation of vitamin D is impaired leading AZD9291 cost to hyperparathyroidism and
CKD mineral and bone disorder (CKD-MBD). Retention of phosphate may begin to occur when renal function falls below 80% of normal. Changes in any of these laboratory values may begin in stage CKD 3, although the presence, rate of change and severity of these abnormal parameters are highly variable among individuals. In a study of 168 consecutive new referrals of patients with stages 2–5 CKD to a CKD clinic, Ravani et al.[43] observed that both 25-hydroxyvitamin D and 1,25-dihydroxyvitamin-D levels were significantly, inversely associated with eGFR. Consequently, the prevalence rates of vitamin D insufficiency and deficiency increased from 62% and 25% in stage 2 CKD to 88% and 56% in stage 5 CKD. Similarly, a cross-sectional study of 15 068 adults participating in the Third National Health and Nutrition Examination Survey (NHANES) reported a strong, inverse association between albuminuria
and serum 25-hydroxyvitamin D concentrations.[44] The objective of this guideline is to review currently available evidence with regards to medical therapies for the management of: hypertension, hypercholesterolaemia, diabetes mellitus, CVD, hyperuricaemia and vitamin D insufficiency GNA12 and deficiency in patients with stage 1–3 CKD. Evidence for lifestyle modification and nutrition is also reviewed. a. We suggest that patients with progressive CKD have individualized diet intervention involving an appropriately qualified dietitian (2C). e. We recommend that early CKD patients restrict their dietary sodium intake to 100 mmol/day (or 2.3 g sodium or 6 g salt per day) or less, as it reduces blood pressure and albuminuria in patients with CKD (1C). g. We suggest that early CKD patients (stages 1–3) should not restrict dietary phosphate intake as restriction of dietary phosphate does not influence renal or cardiovascular outcomes in these patients (2C). h.