The treatment of patients with CKD includes the following aspects:
- Identification of acute signs and treatable causes of CRF;
- Prevent or slow down the progression of CRF: Change of diet, control of hypertension, hyperlipidemia, calcium-phosphorus metabolism and hyperglycaemia;
- Symptomatic treatment of complications: cardiovascular, water and sodium metabolic disorders, hyperkalemia, metabolic acidosis, pruritus, hyperuricemia, anaemia, impaired haemostasis, hypermagnesaemia, gastrointestinal and neuromuscular symptoms.
At CKD stage 5, with eGFR between 5 and 10 ml/min/1.73 m2, the initiation of a maintenance dialysis programme or kidney transplantation is suggested based on individual assessment in order to balance the decision in clinical practice with the patients' wishes and desires, their values, cultural backgrounds and the patients' views on quality of life and risks they may want to take, unless clinical conditions indicate earlier initiation.
The choice between transplantation, haemodialysis or peritoneal dialysis depends on the personal choices of the patient, and his clinical situation as evaluated by the responsible doctor. No difference in survival exists between the two therapies.