International Journal of Clinical Case Reports, 2025, Vol.15, No.4, 171-181 http://medscipublisher.com/index.php/ijccr 174 processed foods and choose more phosphorus from plant sources (because of its lower absorption and utilization rate) (Carrero et al., 2020; Ikizler et al., 2020; Kalantar-Zadeh et al., 2020). More and more people recommend methods such as the Mediterranean diet and plant-based diet because they help reduce inflammation, improve metabolic acidosis and maintain cardiovascular health, but the prerequisite is to carefully monitor the intake of potassium and phosphorus (Chauveau et al., 2018; Carrero et al., 2020; Kalantar-Zadeh et al., 2020). Regular assessment and adjustment of dietary plans are necessary for maintaining adequate nutrition and preventing nutritional deficiencies, especially when CKD worsens or dialysis is initiated (Ikizler et al., 2020; Kim and Jung, 2020). 3.3 Factors affecting dietary guidance and patient compliance Effective dietary management for chronic kidney disease faces many challenges, such as other diseases, psychological state, amount of health knowledge, dietary cultural habits, socio-economic obstacles, etc (Narasaki et al., 2024). Formulating personalized dietary plans based on patients' preferences, social background and educational level is more likely to enable patients to adhere consistently and achieve better clinical outcomes (Hassan, 2024; Pradhan et al., 2025). The assistance of nutritionists, educational programs and digital health tools can all enhance patients' self-management ability, reduce anxiety and improve quality of life (Padial et al., 2024; Khor et al., 2023). The reasons why patients have difficulty adhering to the diet plan include: overly complicated restrictions, difficulty in obtaining help from nutritionists, and lifestyle conflicts caused by diet adjustments (Narasaki et al., 2024; Pradhan et al., 2025). Regular follow-up visits, enhanced communication and mobilization of family support are effective ways to improve patients' cooperation and solve difficulties, because the needs of CKD patients will change with the condition (Khor et al., 2023; Hassan, 2024; Padial et al., 2024). 4 Principles and Choices of Drug treatment 4.1 Common medication types and adjustment strategies for CKD The drug treatment for CKD generally includes antihypertensive drugs, such as angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), receptor blockers, calcium channel blockers, thiazide drugs and cyclodiuretics. There are also mineralocorticoid receptor antagonists (Sinha and Agarwal, 2018; Pugh et al., 2019). The selection of these drugs should be based on the patient's CKD stage, other diseases and the risk of complications. Some newly developed drugs, such as sodium-glucose cotransporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1 RA), and non-steroidal mineralocorticoid receptor antagonists (nsMRAs), have additional benefits in slowing the development of CKD and reducing the risk of cardiovascular disease. It is particularly effective for diabetic patients (Shabaka et al., 2021; Tarun et al., 2023; Adamczak et al., 2024; De Nicola et al., 2024). With the decline of renal function, patients need regular check-ups and the medication regimen adjusted according to the situation, because CKD can affect the metabolism of drugs in the body and increase the risk of poisoning (Tarun et al., 2023). Therefore, adjusting the dosage, rationally selecting drugs and avoiding the use of drugs that are harmful to the kidneys are very important measures. For instance, thiazide diuretics may be more effective in advanced CKD, while beta-blockers are now also being used more frequently in dialysis patients (Sinha and Agarwal, 2018). In addition, the treatment approach of reducing blood potassium enables patients to use higher doses of renin-angiotensin system inhibitors, thereby better protecting renal function (Shabaka et al., 2021; De Nicola et al., 2024). 4.2 Individualized dose adjustment and prevention of nephrotoxicity Due to the reduced ability of CKD patients to excrete drugs and their greater sensitivity to drug side effects, the drug dosage should be adjusted according to the specific situation of each individual. The dosage should be determined based on the estimated glomerular filtration rate (eGFR), and the efficacy of the drug and whether there are any toxic or side effects should be checked regularly. For example, when using artemisinin-based drugs, the dosage should be appropriately adjusted and the levels of blood potassium and creatinine should be closely
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