2024 Hong Kong Consensus Released, 14 Recommendations To Help CKD Management
Sep 13, 2024
Chronic kidney disease (CKD) is the leading cause of death for 800 million people worldwide, placing a significant burden on the medical system. At present, there is no consensus on the early identification and early intervention of CKD in some parts of my country, and there is a lack of treatment guidelines for CKD and diabetes.
On August 27, 2024, nephrologists from Hong Kong jointly drafted a CKD management consensus for Hong Kong, my country, and identified 14 CKD-centered recommendations involving the definition, screening, diagnosis, and treatment of the disease. This article organizes them for readers.
Definition of CKD
Click to Cistanche for kidney disease
1. Chronic kidney disease is defined as abnormal kidney structure or function, which has an impact on health and lasts ≥3 months (evidence quality 1; consensus: 93%).
Screening for CKD
2. People with hypertension, diabetes, or cardiovascular disease should be screened for CKD (evidence quality: 1; consensus: 100%).
3. Screening and risk stratification of CKD must include a comprehensive assessment of estimated glomerular filtration rate (eGFR) and albuminuria (i.e., albuminuria to creatinine ratio [UACR]). If UACR is limited, point-of-care proteinuria testing, urine protein to creatinine ratio (UPCR), or urine protein test strips should be used as alternatives. (Evidence quality: 3; Consensus: 100%)
Disease monitoring for CKD
4. Patients with early CKD should have their eGFR and UACR monitored at least annually, while those with advanced CKD or those at higher risk of progression should be monitored more frequently. (Evidence quality: 1; Consensus: 100%)
5. Early identification and treatment of CKD require the recognition and involvement of clinicians, including (but not limited to) nephrologists, endocrinologists, cardiologists, and primary care physicians. (Evidence quality: 1; Consensus: 93%)
Lifestyle management of patients with CKD
6. Patients with CKD should quit smoking, maintain a normal weight, and avoid processed foods high in salt and phosphorus. (Evidence quality: 1; Consensus: 100%)
7. It is recommended that patients with diabetes and CKD perform moderate-intensity physical activity, with a cumulative time of ≥150 minutes per week, or reach a level consistent with their cardiovascular and physical tolerance. (Evidence quality: 1; Consensus: 100%)
Treatment of CKD
8. For CKD patients with diabetes and eGFR≥30ml/min/1.73㎡, metformin is the first-line drug for glucose control. (Evidence quality: 1; Consensus: 100%)
9. For CKD patients with diabetes and hypertension or albuminuria, renin angiotensin aldosterone receptor inhibitors (ACEI) or angiotensin receptor II antagonists (ARB) should be used as the first-line drug treatment for kidney protection and blood pressure control, and the maximum tolerated dose should be adjusted. (Evidence quality: 1; Consensus: 100%)
10. For patients with CKD and type 2 diabetes with eGFR ≥ 20 ml/min/1.73 m2, sodium glucose cotransporter 2 inhibitors (SGLT-2i) can be started as the first-line drug for controlling blood sugar and protecting kidneys and cardiovascular. (Evidence quality: 1; Consensus: 93%)
11. For patients who have received the maximum tolerated dose of ACEI or ARB treatment, but have eGFR ≥ 25 ml/min/1.73 m2, UACR ≥ 30 mg/g (≥ 3 mg/mmol), and normal blood potassium, non-steroidal mineralocorticoid receptor antagonists (MRA) can be used for treatment to maximize the protection of the patient's kidneys and cardiovascular. (Evidence quality: 1; Consensus: 86%)
12. For patients with CKD and type 2 diabetes who cannot receive metformin and SGLT-2i treatment, glucagon-like peptide-1 receptor agonists (GLP-1RA) can be used for treatment. (Evidence quality: 1; Consensus: 100%)
13. For non-diabetic CKD patients with UACR ≥ 200 mg/g (≥ 20 mg/mmol), the maximum tolerated dose of ACEI or ARB should be used for treatment to control blood pressure and protect the kidneys. (Evidence quality: 2; Consensus: 100%)
14. For non-diabetic CKD patients with eGFR ≥ 20 ml/min/1.73 m2 and UACR ≥ 200 mg/g (≥ 20 mg/mmol), SGLT-2i can protect the patient's kidney and cardiovascular function. (Evidence quality: 1; Consensus: 100%)
How Does Cistanche Treat Kidney Disease?
Cistanche is a traditional Chinese herbal medicine used for centuries to treat various health conditions, including kidney disease. It is derived from the dried stems of Cistanche deserticola, a plant native to the deserts of China and Mongolia. The main active components of cistanche are phenylethanoid glycosides, echinacoside, and acteoside, which have been found to have beneficial effects on kidney health.
Kidney disease, also known as renal disease, refers to a condition in which the kidneys are not functioning properly. This can result in a buildup of waste products and toxins in the body, leading to various symptoms and complications. Cistanche may help treat kidney disease ase through several mechanisms.
Firstly, cistanche has been found to have diuretic properties, meaning it can increase urine production and help eliminate waste products from the body. This can help relieve the burden on the kidneys and prevent the buildup of toxins. By promoting diuresis, cistanche may also help Reduce high blood pressure, a common complication of kidney disease.
Moreover, cistanche has been shown to have antioxidant effects. Oxidative stress, caused by an imbalance between the production of free radicals and the body's antioxidant defenses, plays a key role in the progression of kidney disease. ies help neutralize free radicals and reduce Oxidative stress, thereby protecting the kidneys from damage. The phenylethanoid glycosides found in cistanche have been particularly effective in scavenging free radicals and inhibiting lipid peroxidation.
Additionally, cistanche has been found to have anti-inflammatory effects. Inflammation is another key factor in the development and progression of kidney disease. Cistanche's anti-inflammatory properties help reduce the production of pro-inflammatory cytokines and inhibit the activation of inflammation mandatory pathways, thus alleviating inflammation in the kidneys.
Furthermore, cistanche has been shown to have immunomodulatory effects. In kidney disease, the immune system can be dysregulated, leading to excessive inflammation and tissue damage. Cistanche helps regulate the immune response by modulating the production and activity of immune cells, such as T cells and macrophages. This immune regulation helps reduce inflammation and prevent further damage to the kidneys.
Moreover, cistanche has been found to improve renal function by promoting the regeneration of renal tubes with cells. Renal tubular epithelial cells play a crucial role in the filtration and reabsorption of waste products and electrolytes. In kidney disease, these cells can be damaged, leading to damaged renal function. Cistanche's ability to promote the regeneration of these cells helps restore proper renal function and improve overall kidney health.
In addition to these direct effects on the kidneys, cistanche has been found to have beneficial effects on other organs and systems in the body. This holistic approach to health is particularly important in kidney disease, as the condition often affects multiple organs and systems. che has been shown to have protective effects on the liver, heart, and blood vessels, which are commonly affected by kidney disease. By promoting the health of these organs, cistanche helps improve overall kidney function and prevent further complications.
In conclusion, cistanche is a traditional Chinese herbal medicine used for centuries to treat kidney disease. Its active components have diuretic, antioxidant, anti-inflammatory, immunomodulatory, and regenerative effects, which help improve renal function and protect the kidneys from further damage. , cistanche has beneficial effects on other organs and systems, making it a holistic approach to treating kidney disease.
