The rationale for early management of chronic renal insufficiency.
Several strategies are available to delay progression of renal disease and the development of associated co-morbidities. Hypertension is a strong independent risk factor for end-stage renal disease (ESRD) and there is consensus that blood pressure (BP) management is an important aspect of care in patients with chronic renal insufficiency (CRI). Clinical studies have shown that angiotensin-converting enzyme (ACE) inhibitors have renoprotective properties, independent of their antihypertensive effects, which can delay the onset of ESRD. Studies have also shown that intensive therapy of both type 1 and type 2 diabetes patients, to give near normal blood glucose concentrations, can reduce the incidence of progressive clinical proteinuria and may, therefore, protect against ESRD. Additionally, data are emerging that treatment of renal anaemia with epoetin can reduce mortality and delay the onset of dialysis in CRI patients, but these encouraging results need to be confirmed in large prospective studies. In conclusion, control of BP and hyperglycaemia, as well as use of ACE inhibitors and anaemia treatment, all have potential in delaying the progression of CRI or improving patient outcomes. If benefit is proven in future studies, these strategies will be most effective if implemented early in the course of CRI.
Muirhead
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University of Western Ontario, London Health Science Centre, 5339 Windermere Road, London, Ontario N6A 5A5, Canada.
D000740:Anemia / Q000628:therapy; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D003920:Diabetes Mellitus / Q000178:diet therapy / Q000628:therapy; D004044:Dietary Proteins / Q000008:administration & dosage; D006801:Humans; D006949:Hyperlipidemias / Q000628:therapy; D006973:Hypertension / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000628:therapy*; D011507:Proteinuria / Q000188:drug therapy; D013997:Time Factors
D000806:Angiotensin-Converting Enzyme Inhibitors; D004044:Dietary Proteins