Table 2.

Established and future Management strategies for ORCKD.

	Antilpidemics; Triglyceride lowering medications	Particularly in ORCKD patients with known persistent hypertriglyceridemia and/or confirmed renal steatosis on imaging/renal biopsy; Fibrates, niacin, fish oil analogs and derivatives, icosapent ethyl etc
	Uric acid modulators; Xanthine oxidase inhibitors and uricosurics	Particularly in ORCKD patients with known nephrolithiasis, nephrocalcinois, known hyperuricemia and/or hyperuricosuria; Allopurinol, febuxostat, probenecid etc.
Putative and Experimental adjuncts
	Anti-inflammatory agents	Limited human clinical data; No FDA approved options;?? Colchine utility based on small case series
	Endothelin Receptor blockers	Clinical trials; No clinically available nor FDA approved options
	CD-36 inhibitors	Pre-Clinical and animal model trials
	Vasopressin Receptor antagonists (V1a, V1b and V2 receptor blockers)	May have potential utility in ORCKD patients with associated polycystic kidney disease and particularly in ADPKD patients with superimposed ORCKD; tolvaptan, satavaptan, lixivaptan and conivaptan
	Fecal microbiota modulation	Limited clinical data and no clinical practice guidelines; use of pre-pro and post biotic supplements, potential of fecal transplantation in select patients. Clinical trial stage.
	Melatonin supplementation and Melatonin receptor modulation	Limited human clinical data and no clinical practice guideline. Not FDA approved?? utility of low to mid dose melatonin replacement therapy. Early clinical trial stage.
	FXR receptor activation	Preclinical trial stage; experimental
	Anti-oxidants	Limited clinical data. No clinical practice guidelines and no FDA approved options.
	SREBP-1 modulators	Preclinical trial stage; experimental
	M−Tor inhibitors	Preclinical trial stage; experimental
	Aldosterone Synthase inhibitors	Limited available human clinical data. No FDA approved options; early stages of clinical development. May have particular utility in ORCKD patients with coexisting primary aldosteronism. Osilodrostat, Baxdrostat, Lorundrostat etc.
	Vitamin D receptor agonists and modulators	Limited available clinical trial data. In early stages of clinical development. May unique niche of utility in ORCKD patients with coexisting secondary or tertiary hyperparathyroidism. Calcitriol, paricalcitol, doxercalciferol, alfacalcidol etc.
Patients with ORCKD and ESRD	Renal Replacement therapy	Hemo and/or peritoneal dialysis with the unique difficulties and challenges of the obese ORCKD patient. Renal transplant.