Optimizing care for chronic kidney disease: Considerations from A to Z.

Chronic kidney disease (CKD) management requires a comprehensive and multidisciplinary approach to optimize clinical outcomes. This review systematically outlines essential components of CKD care from A to Z, offering evidence-based guidance to enhance patient management. Anemia treatment emphasizes iron supplementation, erythropoiesis-stimulating agents, and novel hypoxia-inducible factor prolyl hydroxylase inhibitors. Achieving optimal blood pressure control through renin-angiotensin system inhibitors and calcium channel blockers reduces cardiovascular risk and delays CKD progression. Cardiovascular risk management includes statins combined with ezetimibe or proprotein convertase subtilisin/kexin type 9 inhibitors, along with appropriate anticoagulation therapy for atrial fibrillation. Individualized glycemic control strategies prioritize sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists for their cardiovascular and renal protective effects. Vigilance in avoiding nephrotoxic agents, such as non-steroidal anti-inflammatory drugs, proton pump inhibitors, aminoglycosides, and contrast media, is essential for preventing renal injury. Rigorous management of electrolytes and acid-base disturbances, involving dietary sodium and potassium restrictions, phosphate binders, and bicarbonate supplementation, reduces CKD progression and related complications. Appropriate fluid management through dietary sodium and water restriction with individualized diuretic therapy prevents volume overload and associated cardiovascular complications. Nutritional interventions, particularly low-protein diets supplemented with ketoanalogues of amino acids, effectively delay CKD progression and control metabolic disturbances. Therapies addressing CKD-related mineral and bone disorders, including phosphate binders, vitamin D analogues, and calcimimetics, reduce the risk of vascular calcification. In addition, lipid-lowering therapies, anticoagulation therapy, optimal vascular access management for dialysis, and early detection of arrhythmias and thrombotic microangiopathy significantly enhance patient outcomes. Attention to quality of life issues, such as alleviating xerosis symptoms, promoting optimal body mass index through weight management strategies, and providing psychosocial support, further enhances patient-centered care. This comprehensive review highlights the crucial importance of a multidisciplinary approach in CKD management.