Can the rate of progression of chronic renal failure be altered?

The cost of renal replacement therapy for end-stage renal disease in the United States exceeds three billion dollars per year. Nonimmunologic mechanisms may contribute to progressive renal injury in renal failure of diverse etiologies. Based on the potential adverse renal effects of these processes, a number of dietary and pharmacologic interventions have been proposed as being potentially beneficial in slowing the rate of progression of chronic renal failure to end-stage renal disease. This article reviews current evidence in animal models and humans supporting the efficacy of each of the proposed interventions.