What have we learned from clinical trials on prevention?

The incidence of end-stage renal disease is increasing at an alarming rate. While diabetes is now the most common cause of renal failure, hypertension commonly coexists, exacerbating renal damage and the other vascular complications of diabetes. Clinical trials have shown the benefits of intervention strategies that target not only the retardation of renal disease, but also the primary prevention of the conditions known to cause renal damage. These strategies include: lifestyle modification programs to prevent diabetes and hypertension; aggressive treatment of established hypertension; combination antihypertensive regimens; and the use of angiotensin-converting-enzyme inhibitors and angiotensin II receptor blockers for additional renoprotection beyond that of blood pressure control. In addition, albuminuria and proteinuria have emerged as powerful predictors of progression of renal disease. The present paper reviews the results of available clinical trials and meta-analyses on these interventional strategies, and highlights the potential of albuminuria and proteinuria in predicting renal and cardiovascular outcomes.