Pharmacotherapy of end-stage renal disease.
BACKGROUND
The incidence and prevalence of end-stage renal disease (ESRD) requiring renal replacement therapy (RRT) continues to grow worldwide. ESRD causes significant morbidity and mortality and has enormous financial and personal costs.


METHODS
Major electronic databases (including the Cochrane Library, MEDLINE and EMBASE) were searched from 1989 to September 2009 to summarize current pharmacotherapy of ESRD-associated complications in adults receiving maintenance dialysis (hemodialysis or continuous ambulatory peritoneal dialysis). Current guidelines for the treatment of ESRD (e.g., NKF-K/DOQI, KDIGO, and the ERA-EDTA's European Renal Best Practice Guidelines) were included.


RESULTS
Commonly used pharmacological treatment strategies for chronic arterial hypertension, anemia, iron management, dyslipidemia, hyperglycemia, and for disturbances of bone and mineral metabolism, including hyperphosphatemia and secondary hyperparathyroidism in ESRD, are presented. In addition, the reader will learn that nonadherence to oral medication in ESRD can contribute significantly to excess morbidity and mortality of the dialysis population.


CONCLUSIONS
Improvements in pharmacotherapy of ESRD may be at least in part counteracted by continuously increasing age and comorbid disease of the dialysis population. Individualized and tailor-made pharmacological management of the ESRD patient remains a challenge for the future.
Schmid
Holger
H
KFH Nierenzentrum Muenchen Laim, Elsenheimerstrasse 63, D-80687 Munich, Germany. hschiffl@hotmail.com
Schiffl
Helmut
H
Lederer
Stephan R
SR
D000740:Anemia / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D016206:Databases, Bibliographic; D050171:Dyslipidemias / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D054559:Hyperphosphatemia / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D058085:Iron Compounds / Q000008:administration & dosage; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D010531:Peritoneal Dialysis, Continuous Ambulatory; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis
D058085:Iron Compounds; D004364:Pharmaceutical Preparations