Management of the patient with chronic renal failure in the evidence based era

Chronic renal failure is a growing problem with an increasing number of patients suffering from loss of kidney function. The morbidity and mortality of these patients is much higher than that of the general population. The patient with chronic kidney disease, even with only a moderate level of renal failure, falls in the highest risk category for cardiovascular disease. A proper evaluation and management of these patients is necessary to prevent further loss of kidney function, to prevent cardiovascular diseases and to manage the co-morbid conditions associated with renal failure and the complications due to renal failure. The therapies available for these purposes in adult patients with chronic renal disease not (yet) in dialysis, are presented in this article, with emphasis on blood pressure management, antiproteinuric therapies, correction of renal anaemia, approach of lipid disorders. A timely referral to a nephrologist is also shown to be important.