[Polypharmacological approach to progressive chronic kidney disease: the new scenery].
End-stage renal disease (ESRD) is a social and economical threat worldwide. Much has been done in previous decades to develop new treatments, but we remain a long way from being satisfied. Recently, growing attention has been paid to polytherapeutic approaches to chronic kidney disease (CKD) to control different causal factors involved in progression and in the meantime, and reduce them as much as possible. Starting from a paper published in the British Medical Journal, which suggested the use of a polypill to prevent cardiovascular events in the general population, I tried to apply a similar approach in the nephrology setting, focusing my attention on therapeutic strategies to slow down CKD progression, which could possibly be included in a 'anti-dialysis polypill'. Among these strategies, I selected the effect of the inhibition of the renin-angiotensin system, the use of statins and anemia correction. Unfortunately, this approach is not applicable theoretically, due to the lack of a sufficient number of randomized clinical trials calculating the relative risk, in particular concerning the use of statins and the treatment of anemia. However, while awaiting new therapeutical approaches to be more selective and efficacious, a treatment combination seems to be, together with better implementation of single therapies, the only possible strategy to apply.
Del Vecchio
L
L
Divisione di Nefrologia e Dialisi, Ospedale A. Manzoni, Lecco-Italy. l.delvecchio@ospedale.lecco.it
D000740:Anemia / Q000209:etiology; D004359:Drug Therapy, Combination; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy* / Q000209:etiology