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Hypertension & Hyperlipidaemia7,8
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Atherosclerosis/ Cardiovascular Disease5
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Chronic Kidney Disease |
Stroke5
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Lifestyle
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Medical clearance may be recommended for exercise
Low protein diet (Limit to 2 servings of protein daily or <0.8g/kg/day)
For later CKD stages, ↓potassium, ↓phosphate & fluid restriction
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BP
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LDL-cholesterol
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HbA1c
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Medication adjustment |
Avoid diuretics
Avoid β-blockers
ACE-I or ARB are preferred for BP control or albuminuria
Fenofibrate for raised TG
Metformin, SGLT2-inhibitor preferred for obese patients
Whilst statins are generally the preferred choice for lipid disorders, the addition of fenofibrate to a statin may benefit certain patients with T2DM with both high TG and low HDL-cholesterol dyslipidaemia pattern, particularly those with microvascular complications.8
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ACE-I or ARB preferred
Consider to start and continue β-blockers indefinitely
Beware of postural hypotension from HTN and BP-lowering CVD drugs (e.g., ISDN)
Start anti-platelets (beware of low Hb with anti-platelets)
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Maximise ACE-I or ARB dosage
Titrate oral glucose lowering agents and insulin as patients more susceptible to hypoglycaemia
Use metformin, diuretics & fenofibrate with caution
Fibrates can be used in patients in stage 1 to 3 CKD but the dosages should be reduced, with appropriate monitoring for side effects, especially myopathy. Fibrates are contraindicated for stage 4 or 5 CKD.8
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Beware of postural hypotension from HTN and BP-lowering CVD drugs e.g. ISDN
Beware of low Hb with anti-platelets
Antithrombotic therapy, including antiplatelet or anticoagulant agents, is recommended for nearly all patients without contra-indications
High dose statin ± ezetimibe
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Others
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For stage 3-5 CKD, consider checking calcium, phosphate, vitamin D, Hb and Ferritin levels
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