Chronic kidney disease is a progressive disease with no cure and high morbidity and mortality that occurs commonly in the general adult population, especially in people with diabetes and
hypertension. Preservation of kidney function can improve outcomes and can be achieved through non-pharmacological strategies (eg, dietary and lifestyle adjustments) and
chronic kidney disease-targeted and
kidney disease-specific pharmacological interventions. A plant-dominant, low-
protein, and
low-salt diet might help to mitigate glomerular hyperfiltration and preserve renal function for longer, possibly while also leading to favourable alterations in
acid-base homoeostasis and in the gut microbiome.
Pharmacotherapies that alter intrarenal haemodynamics (eg,
renin-
angiotensin-
aldosterone pathway modulators and SGLT2 [SLC5A2] inhibitors) can preserve kidney function by reducing intraglomerular pressure independently of blood pressure and
glucose control, whereas other novel agents (eg, non-steroidal
mineralocorticoid receptor antagonists) might protect the kidney through anti-inflammatory or antifibrotic mechanisms. Some glomerular and
cystic kidney diseases might benefit from disease-specific
therapies. Managing
chronic kidney disease-associated cardiovascular risk, minimising the risk of
infection, and preventing
acute kidney injury are crucial interventions for these patients, given the high burden of complications, associated morbidity and mortality, and the role of non-conventional risk factors in
chronic kidney disease. When
renal replacement therapy becomes inevitable, an incremental transition to dialysis can be considered and has been proposed to possibly preserve residual kidney function longer. There are similarities and distinctions between kidney-preserving care and supportive care. Additional studies of dietary and pharmacological interventions and development of innovative strategies are necessary to ensure optimal kidney-preserving care and to achieve greater longevity and better health-related quality of life for these patients.