1. Classify kidney disease using a prediction equation, preferably with a GFR calculator.
2. Manage patients by monitoring their eGFR slope over time - it's all in the slope - the flatter the slope the better it is!
3. Risk stratify the likelihood of kidney progression by using albuminuria - albuminuric patients progress.
4. Make sure all patients with CKD are on some form of renin-angiotensin blockade, especially protienuric patients and those with diabetes
5. Aim for a blood pressure of less than 140/90 mmHg; less than 140/80 mmHg for diabetics per ADA guidelines.
6. Don't routinely stop RAAS blockade if the patient develops stage 4 or 5 CKD - they benefit from RAAS blockade at all stages as long as they tolerate the medication.
7. Blood pressure in most CKD patients is hard to control to target levels - accept this and try the best you can by using multiple strategies - non-pharmacologic (salt restriction, weight management etc) and multiple agents.
8. Make sure exposure of patients to nephrotoxic drugs is minimized - contrast agents, NSAIDs, phosphate-containing bowel preparations.
9. Treat anemia but target all facets - iron deficiency, ESA deficiency, inflammation. Remember that oral iron works well in patients with stage 3 and 4 CKD and is worth trying if patients are able to tolerate the iron.
10. Check the calcium, phosphorous and PTH and treat with a non-calcium containing phosphate binder and active vitamin D. Aim for the upper limit of normal (ULN) for your hospital and adjusted to the PTH assay being used.
