Synopsis
Reduce kidney and cardiovascular events through cause-specific treatment, albuminuria and blood-pressure control, layered protective medicines, and avoidance of preventable injury.
- Treat the cause as well as the risk markers: obstruction, glomerular inflammation, reflux, diabetes and inherited disease cannot be replaced by a generic CKD prescription bundle.
- Blood-pressure control and reduction of albuminuria are central; NICE uses a lower clinic target when ACR is 70 mg/mmol or more, with frailty, falls and home readings shaping individualisation.
- Offer an ACE inhibitor or angiotensin-receptor blocker for eligible albuminuric CKD and titrate to the highest licensed tolerated dose; never combine the two classes solely for proteinuria.
Key red flags
Severe hyperkalaemia or ECG change after RAS blockade or finerenone requires the acute UKKA pathway; do not wait for a routine repeat sample.
Investigation priorities
Guide antihypertensive intensity and identify white-coat, masked or postural patterns.
Management branches
Stable CKD carries albuminuric, diabetic, heart-failure or cardiovascular risk suitable for disease modification.
- Confirm cause, G and A stage, blood pressure, volume, potassium, diabetes status, cardiovascular disease, pregnancy potential and current medicines.
- Optimise a single ACE inhibitor or ARB when indicated, checking renal function and potassium after each meaningful dose change.
Key medicines
ACE inhibitor or angiotensin-receptor blockerStart the selected licensed agent low when clinically appropriate and titrate to the highest tolerated licensed dose with planned creatinine and potassium testing.
SGLT2 inhibitorUse the product and fixed daily dose licensed and commissioned for the person's CKD, diabetes or heart-failure indication, respecting current initiation criteria.