11. Chronic Kidney Disease Recommendations

  • In chronic kidney disease (CKD), the JBS3 risk calculator can be used to highlight the increased CVD risk and to guide appropriate risk factor modification.

Blood pressure

  • In adults with stages 3–5 CKD, with or without diabetes, BP should be treated to maintain systolic <140 mmHg and diastolic <90 mmHg.
  • In adults with CKD, with or without diabetes, in whom urinary albumin excretion exceeds 30 mg/day (equivalent to an ACR of 3 mg/mmol) these targets should be reduced to systolic <130 mmHg and diastolic <80 mmHg.
  • All antihypertensive agents are effective in adults with stages 3–5 CKD. ACE inhibitors or ARBs should be included in the antihypertensive regimen, particularly in people in whom albuminuria >30 mg/day (equivalent to an ACR of 3 mg/mmol).

Lipids

  • In adults with stages 3–5 CKD, lipid-lowering therapy with statins should be considered in all patients.

Aspirin

  • Routine use of aspirin is not recommended for primary prevention in CKD.