International Journal of Clinical Case Reports, 2025, Vol.15, No.4, 171-181 http://medscipublisher.com/index.php/ijccr 175 monitored to prevent hyperkalemia or acute kidney injury (Shabaka et al., 2021; Tarun et al., 2023; Adamczak et al., 2024). Similarly, when CKD patients use oral anticoagulants (DOACs), renal function must also be evaluated to avoid increased risk of bleeding due to drug accumulation (Montomoli et al., 2024). To prevent drug-induced kidney damage, the use of drugs that are harmful to the kidneys should be avoided or minimized as much as possible, such as non-steroidal anti-inflammatory drugs (NSAIDs), certain antibiotics and contrast agents (Shabaka et al., 2021). At present, some new therapeutic approaches, such as SGLT2i and nsMRAs, have performed well in protecting renal function, but still need to be evaluated and monitored based on the specific conditions of the patients (Tarun et al., 2023; Adamczak et al., 2024; De Nicola et al., 2024). The collaboration among nephrologists, pharmacists and other medical personnel is of great significance for improving medication safety and therapeutic effects (Giannese et al., 2023; Danneel et al., 2025). 4.3 Manage comorbidities through combined medication Effective control of other diseases such as hypertension and diabetes is the foundation of CKD care, and combination medication is usually required (Shabaka et al., 2021). Combined use of acei or arb, diuretics, calcium channel blockers and receptor blockers to control blood pressure. The specific use depends on the individual patient's condition and CKD stage (Sinha and Agarwal, 2018; Pugh et al., 2019). SGLT2 inhibitors and GLP-1 receptor agonists are recommended for patients with diabetic nephropathy. They can not only control blood sugar but also protect the kidneys (Tarun et al., 2023; Adamczak et al., 2024; De Nicola et al., 2024). Other complications may complicate the medication, so the treatment plan needs to be carefully adjusted to avoid adverse reactions or toxic accumulation between drugs (Shabaka et al., 2021). Regular examination of the medication list, strengthening of medication guidance for patients, and conducting multidisciplinary cooperation are very important for effectively controlling diseases such as hypertension and diabetes, which helps to improve the therapeutic effect and slow down the progression rate of CKD (Figure 2) (Giannese et al., 2023; Tarun et al., 2023; Adamczak et al., 2024; Danneel et al., 2025). Figure 2 Synergy between nutritional intervention and pharmacological treatment in CKD patients (Adopted from Danneel et al., 2025) Image caption: Abbreviations: ACE-I, angiotensin-converting enzyme inhibitor; ARBs, angiotensin II receptor blockers; EPO, erythropoietin; P-binders, phosphorus binders; SGLT2i, sodium-glucose cotransport type 2 inhibitor (Adopted from Danneel et al., 2025) 5 Multi-disciplinary Comprehensive Management Model 5.1 The role of multidisciplinary team (MDT) in CKD nursing Multidisciplinary team (MDT) collaboration is the cornerstone for improving CKD management, involving nephrologists, nurses, dietitians, pharmacists, social workers, and other professionals to jointly provide integrated care for patients (Shi et al., 2017; Collister et al., 2019; Hsu et al., 2020; Elendu et al., 2023). Projects such as LUCID and virtual care represent this type of integrated care model (Fritz, 2023; Major et al., 2025).
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