The aim is to:
- Prevent progression of CRF so far as possible
- Prevent complications of CRF
- Ensure timely and appropriate planning of RRT when necessary (see Preparing patients for RRT)
| Fluid balance | Prevent hypervolaemia (Na restriction, diuretics) Avoid hypovolaemia (no oedema, postural hypotension) Watch out for sodium-losing patients who will benefit from Na supplementation. |
| Hypertension | See blood pressure in renal disease |
| Diet | See diet |
| Hyperlipidaemia | See hyperlipidaemia |
| Acidosis | Prescribe NaHCO3 to keep plasma bicarbonate ≥20 if Na load perm |
| Osteodystrophy | Prescribe alfacalcidol (calcitriol equally effective) when there is hypocalcaemia or when PTH >2x normal in the presence of normal serum calcium. PO4 should be kept at ≤1.8 mmol/l by dietary restriction and the use of phosphate binders. See osteodystrophy |