Advances in the management of chronic kidney disease

BMJ. 2023 Dec 5:383:e074216. doi: 10.1136/bmj-2022-074216.


Chronic kidney disease (CKD) represents a global public health crisis, but awareness by patients and providers is poor. Defined as persistent abnormalities in kidney structure or function for more than three months, manifested as either low glomerular filtration rate or presence of a marker of kidney damage such as albuminuria, CKD can be identified through readily available blood and urine tests. Early recognition of CKD is crucial for harnessing major advances in staging, prognosis, and treatment. This review discusses the evidence behind the general principles of CKD management, such as blood pressure and glucose control, renin-angiotensin-aldosterone system blockade, statin therapy, and dietary management. It additionally describes individualized approaches to treatment based on risk of kidney failure and cause of CKD. Finally, it reviews novel classes of kidney protective agents including sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, non-steroidal selective mineralocorticoid receptor antagonists, and endothelin receptor antagonists. Appropriate, widespread implementation of these highly effective therapies should improve the lives of people with CKD and decrease the worldwide incidence of kidney failure.

Publication types

  • Review

MeSH terms

  • Angiotensin-Converting Enzyme Inhibitors / pharmacology
  • Diabetes Mellitus, Type 2*
  • Humans
  • Kidney
  • Mineralocorticoid Receptor Antagonists / pharmacology
  • Renal Insufficiency, Chronic* / therapy
  • Renin-Angiotensin System
  • Sodium-Glucose Transporter 2 Inhibitors* / therapeutic use


  • Angiotensin-Converting Enzyme Inhibitors
  • Sodium-Glucose Transporter 2 Inhibitors
  • Mineralocorticoid Receptor Antagonists