Management

Fluid intake: Ensure appropriate fluid intake and avoid dehydration.

Protein and energy consumption

• Mediterranean diet, ↑ fruit and vegetable intake

• Protein restriction (e.g., 0.55–0.60 g/kg/day) in patients with CKD category G3–G5

Electrolytes

• Sodium restriction (< 2.3 g/day)

• Potassium intake adjustment

• Phosphorus intake adjustment

Micronutrients: Consider multivitamin supplementation for patients with inadequate dietary vitamin (e.g., vitamin D) intake.

Renally cleared medications: Adjust dosing based on the patient's eGFR.

Potentially nephrotoxic substances

• Avoid use (except when the benefits outweigh the risks).

• Contrast imaging

  • The risk of contrast-induced nephropathy is highest in patients with eGFR < 30 mL/min/1.73 m2.

  • For information on prevention, see “Contrast-induced nephropathy.”

Nonoperative (hemodialysis or peritoneal dialysis)

• Indications include:

  • Hemodynamic or metabolic complications that are refractory to medical therapy, e.g.:

    • Volume overload or hypertension

    • Metabolic acidosis

    • Hyperkalemia

  • Serositis: e.g., uremic pericarditis

  • Other symptoms of uremia: e.g., signs of encephalopathy

  • Refractory deterioration in nutritional status

Operative: kidney transplantation