Chronic Kidney Disease: Strategies to Retard Progression

Abstract

Chronic kidney disease (CKD), defined as the presence of irreversible structural or functional kidney damages, increases the risk of poor outcomes due to its association with multiple complications, including altered mineral metabolism, anemia, metabolic acidosis, and increased cardiovascular events. The mainstay of treatments for CKD lies in the prevention of the development and progression of CKD as well as its complications. Due to the heterogeneous origins and the uncertainty in the pathogenesis of CKD, efficacious therapies for CKD remain challenging. In this review, we focus on the following four themes: first, a summary of the known factors that contribute to CKD development and progression, with an emphasis on avoiding acute kidney injury (AKI); second, an etiology-based treatment strategy for retarding CKD, including the approaches for the common and under-recognized ones; and third, the recommended approaches for ameliorating CKD complications, and the final section discusses the novel agents for counteracting CKD progression.

Keywords: acute kidney injury; chronic kidney disease; renal progression; therapy for renal failure.

Figure 1

(A) The different declined rates of renal function in CKD with the target switch from superfast to slow rate. (B) The consequence of AKI on CKD progression, depending on the severity and frequency of episodes.

Figure 2

The risk factors and management strategies of CKD development and progression.

Figure 3

The pathogenesis of diabetic nephropathy and mechanism of sodium-glucose cotransporter inhibitors-associated renoprotection.

Figure 4

The structure and action mechanisms of different MRAs generations such as spironolactone, eplerenone, and novel nonsteroidal MRAs (esaxerenone and finerenone). Novel nonsteroidal MRAs exert better anti-fibrotic and anti-inflammatory effects with renal tubular sparing effects on hyperkalemia.

Figure 5

Different causes of nephrolithiasis and urothithiasis with the recommended management strategies to avoid recurrence.

Figure 6

The multiple-faceted mechanisms of metabolic acidosis on renal progression such as enhanced ammonia production in surviving nephrons with complement activation and increased endothelin production, leading to reduced GFR and augmented tubulointerstitial injury.