Stop chronic kidney disease progression: Time is approaching

Table 1 Standard of care therapeutic management

Drug class	On-target parameter	Off-target parameters	Ref.
Antihypertensive
RAS blockers	BP↓	UAE↓, GTP↓, K+↑, AT1-7↑, cytokines↓, Klotho↑	[53,54,56,69-82]
Aldosterone antagonists	BP↓	UAE↓, K+↑	[83-85]
K+ binders
Bisacodyl	K+↓	Diarrhea	[86]
Patiromer	K+↓		[87]
Na zirconium cyclosilicate	K+↓		[88]
Blood sugar control	Blood sugar↓	Progression↓	[93-95]
	HbA1c + 7	Postpones need of Dx
Hypocholestrolemic
Statins	Cholesterol↓, LDL↓	Cardiovascular events↓	[96]
Hypouricemic agents
Allpurinol	Uric acid↓	Renal events↓, CV events↓	[102,103]
Febuxostst	Uric acid↓	CKD progression↓	[104]
Sodium bicarbonate	HCO3-↑, PH ↑	Ptn catabolism↓, GFR decline↓	[105,106]
Phosphate binders
Calcium based	P↓	PTH↓, Vasc calc.↑	[117-120]
Sevelamer	P↓	PTH↓, stop vasc calc, Mortality↓, Uric acid↓, Cholesterol↓, LDL↓, inflammation↓ Cardiovascular events↓	[121-131]
Lanthanum carbonate	P↓	PTH↓, stop vasc calc,	[123-139]
Iron compounds	P↓	Iron↑	[140,141]
Nicotinamide	P↓	TG↓, LDL↓, HDL↑	[142-144]

RAS: Renin angiotensin system; BP: Blood pressure; UAE: Urine albumin excretion; GTP: Glomerular tuft pressure; K: Potassium; AT1-7: Angiotensin 1-7; Dx: Dialysis; LDL: low density lipoprotein; CV: Cardiovascular; CKD: Chronic kidney disease; HCO₃^-: Bicarbonate; Ptn: Protein; GFR: Glomerular filtration rate; P: Phosphorus; PTH: Parathormone; Vasc calc: Vascular calcification; TG: Triglycerides; HDL: High density lipoproteins.