title: Renal failure (chronic).
abstract: BACKGROUND
  Continued progression of renal failure will lead to renal function too low to sustain healthy life. In developed countries, such people will be offered renal replacement therapy in the form of dialysis or renal transplantation. Requirement for dialysis or transplantation is termed end-stage renal disease (ESRD).
  
  
  METHODS
  We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of drug treatments used to reduce progression rate of chronic renal failure? What are the effects of lifestyle changes used to reduce progression rate of chronic renal failure? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
  
  
  RESULTS
  We found 44 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
  
  
  CONCLUSIONS
  In this systematic review we present information relating to the effectiveness and safety of the following interventions: angiotensin II receptor antagonists, angiotensin-converting enzyme (ACE) inhibitors (with or without angiotensin II receptor antagonists), exercise, erythropoiesis-stimulating agents, fibrates, lowering blood pressure below usual targets, nicotinates, psychoeducational intervention, smoking cessation, sodium (dietary), statins, structured programmes to achieve therapeutic goals, and targeted lowering of albuminuria/proteinuria.
authors: McMaster University, Ontario, Canada.
authors: Catherine
authors: C
authors: Clase
references: J Am Soc Nephrol. 2007 Jun;18(6):1889-98
references: 17494885
references: Ann Intern Med. 1995 Nov 15;123(10):754-62
references: 7574193
references: Presse Med. 1984 Oct 27;13(38):2307-10
references: 6239186
references: Am J Kidney Dis. 2002 Feb;39(2 Suppl 1):S1-266
references: 11904577
references: Am J Med. 2003 Apr 1;114(5):347-53
references: 12714122
references: Am J Kidney Dis. 2006 Jul;48(1):8-20
references: 16797382
references: Am J Kidney Dis. 1992 Dec;20(6):618-28
references: 1462992
references: Radiology. 1989 Jan;170(1 Pt 1):51-3
references: 2642347
references: Arch Pathol Lab Med. 1998 Jul;122(7):587-608
references: 9674541
references: Kidney Int. 2004 Sep;66(3):1123-30
references: 15327407
references: Am J Kidney Dis. 2007 Mar;49(3):373-82
references: 17336698
references: Am J Kidney Dis. 2003 Oct;42(4):693-703
references: 14520619
references: Am J Kidney Dis. 2006 Mar;47(3):385-95
references: 16490616
references: Kidney Int. 2005 Jun;67(6):2089-100
references: 15882252
references: Lancet. 2005 Mar 12-18;365(9463):939-46
references: 15766995
references: Am J Kidney Dis. 2000 Aug;36(2):415-8
references: 10922323
references: Kidney Int. 1999 May;55(5):1878-84
references: 10231450
references: Am J Kidney Dis. 2010 Mar;55(3):519-34
references: 20031287
references: Clin Nephrol. 1994 Mar;41(3):167-72
references: 8187361
references: J Am Geriatr Soc. 1985 Apr;33(4):278-85
references: 3989190
references: Scand J Urol Nephrol. 2004;38(5):427-33
references: 15764256
references: J Am Soc Nephrol. 2006 Jul;17(7):2006-16
references: 16762986
references: BMJ. 2008 Mar 22;336(7645):645-51
references: 18299289
references: Intern Med. 2006;45(4):193-8
references: 16543688
references: Ann Intern Med. 1999 Mar 16;130(6):461-70
references: 10075613
references: N Engl J Med. 2006 Jan 12;354(2):131-40
references: 16407508
references: Kidney Int. 1995 Sep;48(3):851-9
references: 7474675
references: J Am Coll Cardiol. 2010 Mar 23;55(12):1266-1273
references: 20206456
references: Lancet. 2008 May 10;371(9624):1575-6
references: 18468534
references: Am J Kidney Dis. 2004 May;43(5):825-35
references: 15112173
references: Kidney Int. 1997 Mar;51(3):850-4
references: 9067920
references: Am J Kidney Dis. 2002 May;39(5):920-9
references: 11979335
references: Am J Kidney Dis. 2006 Jun;47(6):956-64
references: 16731290
references: BMJ. 1990 Mar 3;300(6724):573-8
references: 2108751
references: Am J Kidney Dis. 2002 Apr;39(4):721-9
references: 11920337
references: Kidney Int. 2002 Jun;61(6):2165-75
references: 12028457
references: Kidney Int. 2003 Apr;63(4):1468-74
references: 12631363
references: Arch Intern Med. 2004 Mar 22;164(6):659-63
references: 15037495
references: Am J Kidney Dis. 2006 Nov;48(5):739-51
references: 17059993
references: BMJ. 2004 Oct 16;329(7471):912-5
references: 15485978
references: J Am Soc Nephrol. 2003 Nov;14(11):2934-41
references: 14569104
references: Control Clin Trials. 1996 Aug;17(4 Suppl):40S-46S
references: 8889353
references: Ann Intern Med. 2005 Mar 1;142(5):342-51
references: 15738453
references: Ann Intern Med. 2003 Jul 15;139(2):137-47
references: 12859163
references: Arch Intern Med. 1999 Aug 9-23;159(15):1785-90
references: 10448783
references: Lancet. 2009 Oct 10;374(9697):1226
references: 19819378
references: Am J Med. 1998 Dec;105(6):464-71
references: 9870830
references: Nephron. 1976;16(1):31-41
references: 1244564
references: Nephrol Dial Transplant. 2000 Dec;15(12):1993-9
references: 11096145
references: N Engl J Med. 2009 Nov 19;361(21):2019-32
references: 19880844
references: Am J Kidney Dis. 2010 Apr;55(4):671-81
references: 20097461
references: Kidney Int. 2006 Jan;69(2):375-82
references: 16408129
references: Urol Radiol. 1981;3(1):1-6
references: 7281377
references: Am J Kidney Dis. 2005 Dec;46(6):1088-98
references: 16310575
references: Am J Kidney Dis. 2005 Nov;46(5):863-70
references: 16253726
references: Nephron Clin Pract. 2007;105(4):c178-84
references: 17347576
references: N Engl J Med. 1994 Mar 31;330(13):877-84
references: 8114857
references: Am J Kidney Dis. 2008 Sep;52(3):412-24
references: 18676075
references: Ann Intern Med. 2010 Jul 6;153(1):23-33
references: 20439566
references: Am J Kidney Dis. 2010 Jan;55(1):42-9
references: 19932541
references: JAMA. 2002 Nov 20;288(19):2421-31
references: 12435255
references: J Am Soc Nephrol. 2002 Nov;13(11):2811-2; author reply 2812-6
references: 12397055
references: Lancet. 2003 Jan 11;361(9352):117-24
references: 12531578
references: Nephron. 1997;75(1):36-40
references: 9031268
references: Radiology. 1986 Sep;160(3):659-62
references: 3526405
references: Am J Kidney Dis. 2006 May;47(5):751-60
references: 16632013
references: Ann Intern Med. 2001 Jul 17;135(2):73-87
references: 11453706
references: J Nerv Ment Dis. 1993 Jun;181(6):371-6
references: 8501458
references: N Engl J Med. 2010 Sep 2;363(10):918-29
references: 20818902
references: Circulation. 2011 Mar 15;123(10):1098-107
references: 21357827
references: Am J Kidney Dis. 2005 Mar;45(3):473-84
references: 15754269
references: Circulation. 2006 Jul 4;114(1):26-31
references: 16801465
references: Clin J Am Soc Nephrol. 2006 Jul;1(4):730-7
references: 17699280