Standard of Care for Chronic Kidney Disease: The Four Pillars of Pharmacotherapy - Implications for Nephrology Nursing Practice.

Management of individuals with chronic kidney disease (CKD) has evolved substantially with the emergence of multiple therapies shown to slow progression of kidney disease and reduce cardiovascular risk. The pillars of pharmacotherapy in CKD now include four distinct classes: renin-angiotensin system inhibitors, sodium-glucose cotransporter 2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists, and glucagon-like peptide 1 receptor agonists. As pharmacotherapy becomes more complex, nephrology nurses play a critical role in medication management, patient education, laboratory monitoring, adverse effect mitigation, and interdisciplinary care coordination. This review summarizes the mechanisms, guideline recommendations, safety considerations, and nursing practice implications, while also discussing real-world barriers to implementation and medication access challenges. Nephrology nursing engagement is essential to improving safe and effective use of evidence-based therapies in caring for individuals with CKD.