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Related Experiment Videos

Renoprotection: one or many therapies?

L A Hebert1, W A Wilmer, M E Falkenhain

  • 1Division of Nephrology, The Ohio State University Medical Center, Columbus, Ohio, USA.

Kidney International
|March 22, 2001
PubMed
Summary

This study proposes an expanded renoprotective strategy for progressive renal disease, recommending multiple interventions to slow progression until further evidence is available. This approach aims to reduce the societal burden of end-stage renal disease (ESRD).

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Area of Science:

  • Nephrology
  • Renal disease progression
  • Therapeutic strategies

Background:

  • End-stage renal disease (ESRD) presents a significant individual and societal cost.
  • Current therapies, like angiotensin-converting enzyme (ACE) inhibitors, show renoprotective effects, but widespread testing is infeasible.
  • Nephrologists face a choice between evidence-proven therapies and plausible, prudent interventions.

Purpose of the Study:

  • To provide documentation to guide nephrologists in choosing renoprotective strategies.
  • To present a framework for evaluating and implementing interventions to slow renal disease progression.
  • To support an expanded renoprotection strategy based on plausible efficacy.

Main Methods:

  • Described mechanisms of renal disease progression.

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  • Identified and detailed 18 interventions to slow disease progression.
  • Assigned a level of recommendation (1-3) based on evidence strength for each intervention.

    • Main Results:

    • Four interventions received Level 1 recommendation, four received Level 2, and ten received Level 3.
    • Most patients can implement Level 1 and 2 interventions, and many can achieve Level 3 interventions.
    • Recommended an expanded renoprotection strategy.

    Conclusions:

    • A broad-based, multiple-risk-factor intervention is justifiable for progressive nephropathies.
    • This strategy aims to slow renal disease progression until more definitive data emerge.
    • Detailed practical guidance is provided for clinical nephrologists.