Table 1.
Population-level compliance with strategies for primary and secondary prevention of CKD
| Risk factor | Evidence-based recommendation: guideline-concordant treatment goals and recommended agents | Population-level compliance |
|---|---|---|
| Awareness | Low compliance: 90% of individuals with 2–4 CKD markers and 84% of individuals with ≥5 CKD markers were unaware of their disease61 | |
| Lifestyle | ||
| Overweight | BMI < 25 kg/m2 | |
| Diet | Low salt (<2 g/d) | |
| Smoking | Smoking cessation | |
| Exercise | 30–60 min of exercise 4–7 d/wk | |
| Proteinuria/albuminuria | Monitoring and follow-up Treatment with ACEi/ARBs, with proteinuria >30 mg/mmol or 0.5 g/d |
20% detection rate for CKD-related albuminuria at the community level Prevalence of ACEi/ARB use decreased from 45% in 2006–2008 to 36% in 2012–201466 |
| Blood pressure | <130/80 mmHg (diabetes or proteinuric CKD)a <140/80 mm Hg (nondiabetic or nonproteinuric CKD) |
Prevalence of uncontrolled hypertension (>130/80 mm Hg) was 46%–48% over the past decade66 |
| Diabetes | HbA1c <7% and use of newer agents (i.e., SGLT2 may have role in CKD stages 1–4 for significant cardiovascular and kidney outcomes benefits) | Prevalence of uncontrolled diabetes (HbA1c >7%) was ∼40% in 2012–201466 |
| Dyslipidemia | Use of statinsb | Statin use among patients with CKD aged ≥50 years was low and remained basically unchanged, increasing slightly from 29% in 2006–2008 to 31% in 2012–201466 |
| Cardiovascular | Use of aspirin, beta-blockers among patients with established CVD |
BMI, body mass index; ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin-receptor blocker; CKD, chronic kidney disease; CVD, cardiovascular disease; HbA1c, glycated hemoglobin; SGLT2, sodium-glucose cotransporter-2.
a
Use of ACEi/ARBs recommended.
b
Fire and forget strategy (use of statins among all CKD patients aged >50 years, and no need for serial lipid panels monitoring).