Prepared by: Asst. Lecturer Zainab Ali Mohsen Al-Khafaji.<br /><br /> Introduction<br />CKD is defined by a sustained reduction in estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m² or persistent markers of kidney damage for more than three months. The disease is associated with significantly increased mortality rates, cardiovascular complications, and a decline in patients’ quality of life. Preventing progression of CKD is therefore a priority in clinical practice to delay or avoid the need for renal replacement therapy such as dialysis.<br />Non-Pharmacological Strategies<br />1. Dietary Modification<br />Diet plays a crucial role in slowing CKD progression. Evidence supports:<br /> • Restricting protein intake to 0.6–0.8 g/kg/day reduces intraglomerular pressure.<br /> • Plant-based diets help reduce inflammation, maintain acid–base balance, and improve gut microbiota composition.<br /> • Limiting sodium intake to <2 grams/day aids in blood pressure and fluid control.<br />2. Lifestyle and Physical ActivityModerate-intensity physical activity (150 minutes/week) is recommended to improve cardiovascular fitness, control blood pressure, and preserve kidney function. Weight loss in obese patients and smoking cessation are also critical preventive measures.<br />Targeted Pharmacological Interventions<br />1. Renin-Angiotensin-Aldosterone System (RAAS) Inhibitors<br />ACE inhibitors and ARBs lower intraglomerular pressure and slow disease progression, particularly in patients with proteinuria.<br />2. Sodium-Glucose Co-Transporter 2 Inhibitors (SGLT2i)<br />This class of medications (e.g., dapagliflozin) has shown a ~44% reduction in eGFR decline and significantly lowers heart failure hospitalization risk—even in non-diabetic individuals.<br />3. Emerging Therapies<br />Non-steroidal mineralocorticoid receptor antagonists (e.g., finerenone), acid binders (e.g., veverimer), and potassium binders (e.g., patiromer) offer promising avenues by reducing inflammation, fibrosis, and correcting electrolyte imbalances.<br />Preventing Acute Kidney Injury (AKI) Episodes<br />Protocols to withhold certain medications (e.g., diuretics, RAAS blockers, NSAIDs) during acute illness help prevent AKI. Patient education on “sick day rules” and maintaining proper hydration are key components.<br />Cardiovascular Risk Management<br />Cardiovascular disease is the leading cause of death among CKD patients. Optimal blood pressure, glycemic, and lipid control are essential. SGLT2 inhibitors and GLP‑1 receptor agonists offer cardioprotective benefits and are recommended in appropriate patients.<br />Global Challenges<br />Low- and middle-income countries face diagnostic and therapeutic limitations, making lifestyle and dietary interventions especially critical. In higher-income settings, racial disparities in eGFR calculation have raised concerns about delayed diagnosis and unequal care.<br />Conclusion<br /><br />CKD is a multifaceted global challenge that requires an integrated approach to delay its progression and reduce complications. Combining non-pharmacological measures with evidence-based drug therapies offers the best chance to improve patient outcomes. Continued clinical trials are needed to evaluate emerging therapies and novel approaches such as incremental dialysis and intestinal dialysis<br />Kalantar-Zadeh, K., Li, P. K., Tantisattamo, E., Banerjee, T., Lin, L. H., Gabbai, F. B., … & Jha, V. (2021). Living well with kidney disease by patient and care-partner empowerment: Kidney Health for Everyone Everywhere. Kidney International, 99(2), 278–284.<br /><br />Al-Mustaqbal University ، The First University in Iraq