Balance Medication with Careful Monitoring

In managing patients with chronic kidney disease (CKD), particularly in stages 3 to 5, it is essential to continue the Renin-Angiotensin System (RAS) blockade with ACEs or ARBs as long as blood pressure and potassium levels permit. Potassium binding drugs can help maintain essential neurohormonal blockade for heart and kidney protection. There are specific thresholds for introducing medications like mineralocorticoid receptor antagonists (MRAs) and SGLT2 inhibitors; MRAs should not be initiated if creatinine exceeds 2.5 but can be continued, while SGLT2 use generally stops below a GFR of 20. Clinical decisions should prioritize individual patient assessments rather than rigid adherence to numerical guidelines, as patient responses can vary significantly. Continuous evaluation and flexible medication management are crucial as CKD progresses.