Table 4.

Additional treatment considerations in the management of hypertension and proteinuria in patients with CKD^∗

• Restrict dietary sodium intake to <2.4 g/d (100 mmol/d)

• Restrict dietary protein to ≤1.4 g/kg/d for CKD stages 1–2 or 0.6 to 0.8 g/kg/d for CKD stages 3–4

• Use effective thiazide diuretic therapy for CKD stages 2–3 or use loop diuretics when reestimated GFR is <30 mL/min/1.73 m2 for CKD stages 4–5

• Use moderate to high doses of ACEIs or ARBs

• Modify antihypertensive therapy in patients with a spot urine total protein-to-creatinine ratio >0.5 to 1 mg/g

• Take steps to minimize risk of hyperkalemia induced by ACEI or ARB

∗In addition to reducing systolic blood pressure to 110 to 130 mm Hg and using renin-angiotensin-aldosterone system inhibitor–based combination therapy (1, 49).

ACEI indicates angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; CKD, chronic kidney disease; GFR, glomerular filtration rate.