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A 62-year-old man with a history of chronic kidney disease (CKD), hypertension (HTN), and hyperlipidemia is in clinic for a routine follow-up. He previously was noncompliant with a low-salt diet and anti-hypertensive medications that resulted in persistently elevated blood pressure and CKD progression. In the past year, the man has been taking his medications consistently and is actively trying to keep to a healthier diet. Nevertheless, his blood pressure remains suboptimal. On the day of the routine follow-up visit, his blood pressure was 153/85 mm Hg and his heart rate was 58 bpm. His home blood pressure log shows that his blood pressure typically was 140-150 mm Hg systolic and 80-90 mm Hg diastolic. The patient appears well, with no jugular vein distention (JVD) or peripheral edema. Auscultation of the lungs are clear without any crackles or rhonchi. His medications include the following:

  • Amlodipine 10 mg daily
  • Losartan 100 mg daily
  • Metoprolol succinate 50mg daily
  • Aspirin 81 mg daily
  • Atorvastatin 20 mg daily.

Laboratory studies showed:

  • Serum creatinine 2.95 (eGFR 23 mL/min/1.73m2)
  • Urine albumin/creatinine ratio 830 mg/g
  • Electrolytes are within normal limits.
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