The baby boomers have caused a bulge in the demographic bell curve in more ways than one: the average age of our patients is rising and so too is their average waistline measurement. The concurrent phenomena of the obesity epidemic and the population’s senescence have brought with them higher prevalences of diabetes and hypertension. It should come as no surprise then that chronic kidney disease (CKD) is also on the rise. What family practitioners need to know about how to treat patients with CKD can be summed up with a brief recitation of the first six letters of the alphabet.

Avoid nephrotoxic agents, especially non-steroidal anti-inflammatory agents, including COX-2 inhibitors. If these agents are strongly indicated, use for short durations only and with close monitoring of renal function.

Angiotensin inhibition, in the form of renin-angiotensin-aldosterone system (RAAS) blockers, is indicated, especially to control albuminuria and/or proteinuria, understanding that persistent proteinuria is an important risk factor for progression of CKD.

Appropriate early referral to a nephrologist is important to screen for underlying disease process, reversibility, consideration of specific therapies, and later for preventing complications of CKD and preparation for renal replacement therapy (RRT). RRT prep may take over a year, so refer early.

Blood pressure (BP) control is a priority, with a goal of < 130/80 mm Hg in patients with albuminuria, proteinuria or CKD.

Cardiovascular risk factors — particularly hyperlipidemia and smoking — must be managed to prevent CVD and associated mortality that is common in CKD. Calcium and phosphate control should be considered if the glomerular filtration rate (GFR) falls below 45 ml/min.

Diabetes control should target A_1c < 0.07.

Estimate renal function periodically using an estimated GFR to assess stability and/or progression of CKD.

Educate the patient on the need to temporarily halt RAAS blockers during episodes of dehydration or volume depletion because of the risk of acute deterioration of renal function. RAAS blockers should be reinstated after an assessment of volume status and confirmation of renal function.

Follow-up at periodic intervals depending on the stage of CKD, to monitor and control BP, albuminuria/proteinuria and renal function. Consider consultation with a nephrologist if BP is difficult to control, if there is persistent albuminuria/proteinuria, if the CKD is progressive or if you have other concerns.