336 Ch 335. CKD Treatment — Four Pillars and Emerging Therapies

CKD treatment paradigm 2024 已從只給 ACE/ARB 進入 4 pillars era：(1) ACE/ARB for albuminuria — foundational, established；(2) SGLT2 inhibitors (CREDENCE, DAPA-CKD, EMPA-KIDNEY) — paradigm-shifting；(3) Finerenone (FIDELIO-DKD, FIGARO-DKD) — non-steroidal MRA for DKD + albuminuria；(4) GLP-1 RA (FLOW 2024 semaglutide) — broadest CV + renal benefit；combined effects：4 pillars can ↓ CKD progression > 50% in DKD；adjunctive therapies：statin (primary prevention if eGFR < 60 + albuminuria), BP control (< 130/80), HbA1c (< 7% individualized), nutrition counseling (Na/PO4/K)；management of complications：anemia (iron + ESAs + HIF-PHIs), CKD-MBD (binders + vit D + calcimimetics), hyperkalemia (binders), acidosis (NaHCO3)；emerging：inaxaplin (APOL1 nephropathy), bardoxolone withdrawn (CV risk), endothelin antagonists (atrasentan/sparsentan) for FSGS + IgA, complement inhibitors for C3G + lupus + aHUS。