Delaying progression of chronic kidney disease
What drives CKD progression, how to measure it, and the evidence behind each intervention, from RAS blockade and SGLT2 inhibitors to the treatments that failed (allopurinol, bicarbonate in older people, stopping ACE inhibitors in advanced CKD).
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Kidney function loss in CKD isn't inevitable. Most of the slowing comes from lowering albuminuria and intraglomerular pressure.
- The core drugs are RAS blockade and an SGLT2 inhibitor for almost everyone with albuminuria, with finerenone and a GLP-1 receptor agonist added in type 2 diabetes. Stage, referral and screening are covered in Chronic kidney disease.
- Keep RAS blockade going when eGFR falls under 30 (STOP-ACEi), and don't stop an SGLT2 inhibitor for the expected early eGFR dip.
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Sources
- Chronic Kidney Disease (CKD) Management in Primary Care, 5th editionAU/NZKidney Health Australia, 2024 (current edition, checked November 2026)
- KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney International 2024;105(4S):S117-S314Kidney Disease Improving Global Outcomes, 2024 (current; KDIGO 2027 CKD Guideline on Medications Management draft public review closed 4 November 2026, being revised; checked November 2026)
- KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney DiseaseKidney Disease Improving Global Outcomes, 2021
- Bhandari S et al. Renin-angiotensin system inhibition in advanced chronic kidney disease (STOP-ACEi). N Engl J Med 2022;387:2021-32New England Journal of Medicine, 2022
- EMPA-KIDNEY Collaborative Group. Empagliflozin in patients with chronic kidney disease. N Engl J Med 2023;388:117-27New England Journal of Medicine, 2023
- Heerspink HJL et al. Dapagliflozin in patients with chronic kidney disease (DAPA-CKD). N Engl J Med 2020;383:1436-46New England Journal of Medicine, 2020
- Badve SV et al. Effects of allopurinol on the progression of chronic kidney disease (CKD-FIX). N Engl J Med 2020;382:2504-13New England Journal of Medicine, 2020
- BiCARB study group. Clinical and cost-effectiveness of oral sodium bicarbonate therapy for older patients with chronic kidney disease and low-grade acidosis (BiCARB). BMC Medicine 2020;18:91BMC Medicine, 2020
- Heerspink HJL et al. Finerenone in persons with chronic kidney disease without diabetes (FIND-CKD). N Engl J Med 2026;395:533-45New England Journal of Medicine, 2026
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy