Treatments for Chronic Kidney Disease

Pharmacological treatment of chronic kidney disease (CKD) aims to control associated complications, slow the progression of renal impairment and improve the patient’s quality of life. A combination of medications is used to achieve this, tailored to the stage of the disease and the individual characteristics of each patient:

• Sodium–glucose cotransporter 2 inhibitors (SGLT2 inhibitors): these have been shown to reduce CKD progression and cardiovascular risk in patients both with and without diabetes.
• Diuretics: used to manage fluid retention and hypertension.
• Phosphate binders: essential for preventing disturbances in bone–mineral metabolism associated with CKD.
• Calcium and vitamin D supplements: indicated to maintain bone health and prevent secondary hyperparathyroidism.
• Erythropoietin or erythropoiesis-stimulating agents (ESAs) (stimulates the production of red blood cells): used to treat anaemia secondary to kidney disease.
• Potassium binders: help prevent and treat hyperkalaemia, a potentially serious complication of CKD.
• Antihypertensive therapy: angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin II receptor blockers (ARBs) are the first-line options due to their protective effects on the kidneys and cardiovascular system.

This comprehensive approach is always carried out under specialist supervision, with regular treatment adjustments to ensure maximum efficacy and safety.

It refers to comprehensive medical care without dialysis or a kidney transplant. Its main objective is to control disease progression, relieve symptoms and preserve the best possible quality of life, according to the needs and preferences of each individual.

The approach is particularly appropriate for patients with severe comorbidities, advanced age or significant functional limitations, for whom renal replacement therapies may not provide a clear or desired benefit.

Conservative management includes:

• Blood pressure control, essential to slow the progression of kidney damage and reduce cardiovascular risk.
• Comprehensive management of associated conditions, such as diabetes, obesity and dyslipidaemia, through pharmacological treatment and lifestyle modifications.
• Treatment of CKD-related metabolic complications, including anaemia, hyperkalaemia, metabolic acidosis and mineral and bone metabolism disorders.
• Supervised nutritional support, with individualised dietary recommendations to maintain adequate nutritional status and prevent complications.
• Active symptom management, including fatigue, pruritus, nausea, pain and sleep disturbances, with an approach focused on overall patient well-being.

This type of treatment is always delivered under specialist follow-up, with coordinated, person-centred care that allows clinical decisions to be aligned with disease progression and patient values.