Clinical benefits of slowing the progression of renal failure.
End-stage renal disease is a social and economic threat worldwide. In this context, any medical intervention that may prevent the progression of chronic kidney disease becomes extremely important. Improving the cardiovascular status is another major objective in the management of this population, because cardiovascular disease is the leading cause of morbidity and mortality among dialysis patients. Moreover, this is only the tip of the iceberg, because many patients die before reaching end-stage renal disease. Today, several interventions are available to delay the progressive loss of renal function and/or prevent the development of cardiovascular disease, but we are still far from being satisfied. These interventions include low protein diets, correction of calcium-phosphate disorders and anemia, blood pressure and proteinuria control, and smoking cessation. Other interventions, such as the administration of lipid-lowering agents, are emerging as particularly promising therapeutic approaches. Recently, growing attention has been paid to polytherapeutic approaches to chronic kidney disease, in order to control different causal factors involved in progression and reduce them as much as possible. However, larger prospective, controlled, randomized clinical trials are needed to demonstrate their actual usefulness. All the interventions are likely to be more effective if performed as early as possible in the course of the disease, because it has been widely demonstrated that early and regular nephrologic care is associated with decreased morbidity and mortality.
Locatelli
Francesco
F
Department of Nephrology and Dialysis, A.Manzoni Hospital, Lecco, Italy. nefrologia@ospedale.lecco.it
Del Vecchio
Lucia
L
Pozzoni
Pietro
P
D000740:Anemia / Q000503:physiopathology / Q000628:therapy; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002118:Calcium / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000503:physiopathology / Q000517:prevention & control*; D002908:Chronic Disease; D018450:Disease Progression; D050171:Dyslipidemias / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology; D007674:Kidney Diseases / Q000378:metabolism / Q000503:physiopathology* / Q000628:therapy*; D010710:Phosphates / Q000378:metabolism; D011507:Proteinuria / Q000188:drug therapy / Q000503:physiopathology; D051437:Renal Insufficiency / Q000378:metabolism / Q000503:physiopathology* / Q000628:therapy*; D017582:Renal Replacement Therapy; D016540:Smoking Cessation; D013997:Time Factors
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010710:Phosphates; D002118:Calcium