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Progression of chronic kidney disease: can it be prevented or arrested?

Bertrand L Jaber1, Nicolaos E Madias

  • 1Department of Medicine, Tufts University School of Medicine, Caritas St. Elizabeth's Medical Center, Boston, Mass 02135, USA.

The American Journal of Medicine
|December 28, 2005
PubMed

Insights

Chronic kidney disease (CKD) management requires novel, multifaceted strategies beyond current treatments to halt its progression. Combining targeted therapies and addressing common progression mechanisms may prevent or reverse CKD.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Pharmacology

Background:

  • Chronic kidney disease (CKD) is a global health issue with significant cardiovascular morbidity.
  • Current treatments like blood pressure control and renin-angiotensin system blockade have limitations in halting CKD progression.
  • Achieving optimal therapeutic targets requires novel strategies interrupting multiple disease mechanisms.

Purpose of the Study:

  • To review current understanding of CKD progression.
  • To explore novel and multifaceted treatment strategies for managing CKD.
  • To identify approaches that can prevent, arrest, or potentially reverse CKD progression.

Main Methods:

  • Review of established and emerging therapeutic strategies for CKD.
  • Discussion of cause-specific treatments (e.g., immunosuppression, glycemic control, gene therapy).
  • Examination of interventions targeting common CKD progression pathways (e.g., blood pressure control, antifibrotic therapy, antioxidant therapy).

Main Results:

  • Current therapies slow but do not stop CKD progression, with glomerular filtration rate declines of 2-8 mL/min/y.
  • Optimal targets include proteinuria <500 mg/day and glomerular filtration rate decline of 1 mL/min/y.
  • A combination of novel and established approaches is necessary to achieve therapeutic goals.

Conclusions:

  • A concerted, multifaceted approach is essential for effective CKD management.
  • Interfering with multiple common and specific progression mechanisms offers the best chance to halt or reverse CKD.
  • Novel strategies, including targeted therapies and lifestyle modifications, hold promise for improved CKD outcomes.

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