Recommendations include use of ACE-I or ARB to slow CKD progression in patients with hypertension and albuminuria<\/p>\n<\/h3>\n
By Elana Gotkine HealthDay Reporter<\/b>
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TUESDAY, Jan. 6, 2026 (HealthDay News) — In a clinical practice guideline (CPG) issued by the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) and published online Dec. 30 in the Annals of Internal Medicine<\/em>, updated recommendations are presented for the primary care management of chronic kidney disease (CKD).<\/p>\n Amy R. Schwartz, M.D., from the VA Connecticut Healthcare System in West Haven, and colleagues updated the 2019 VA\/DoD CPG for primary care management of CKD. Twelve key questions were developed to guide the evidence review.<\/p>\n The guidelines encompass 23 recommendations for the diagnosis, assessment, and monitoring of CKD; general management strategies; pharmacologic management of CKD and associated conditions; and contrast-associated acute kidney injury management. The guidelines include a strong recommendation for using urine albumin-to-creatinine ratio and estimated glomerular filtration rate for predicting CKD progression. Use of either an angiotensin-converting enzyme inhibitor (ACE-I) or an angiotensin II receptor blocker (ARB) is strongly recommended to slow progression of CKD in patients with hypertension and albuminuria. In patients with CKD who have one or more of type 2 diabetes, albuminuria, or heart failure, sodium-glucose cotransporter 2 inhibitors are strongly recommended in addition to maximally tolerated ACE-Is or ARBs to reduce the risk for major adverse cardiovascular events (MACE), heart failure, progression of kidney disease, and mortality. To reduce CKD progression, MACE, and all-cause mortality, the addition of a glucagon-like peptide-1 receptor agonist to an ACE-I or ARB is strongly recommended in patients with type 2 diabetes and albuminuric CKD.<\/p>\n “The VA\/DoD CPG provides primary care clinicians with up-to-date practical recommendations for accurately staging CKD, predicting progression to kidney failure, and using pharmacotherapies to prevent progression to kidney failure and reduce the risk for MACE,” the authors write.<\/p>\n