Mechanisms and treatment of CKD

Area of Science:

• Nephrology
• Cardiovascular Medicine
• Pharmacology

Background:

• Chronic kidney disease (CKD) is a growing global health concern with significant financial implications.
• Glomerular hypertension and proteinuric kidney disease are key drivers of CKD progression.
• Proteinuria is an independent predictor of CKD progression, and its reduction is renoprotective.

Purpose of the Study:

• To evaluate the efficacy of renin-angiotensin system (RAS) inhibitors in managing CKD progression.
• To assess the role of RAS inhibitors in reducing proteinuria and preserving kidney function.
• To explore the impact of RAS inhibitors on cardiovascular outcomes in diabetic kidney disease.

Main Methods:

• Comparative analysis of RAS inhibitors (ACE inhibitors and ARBs) versus non-RAS inhibitors for proteinuria reduction and CKD progression.
• Evaluation of RAS inhibitors' effects on kidney function and end-stage renal disease (ESRD) in CKD patients.
• Assessment of ACE inhibitors' impact on cardiovascular mortality in diabetic patients with renal disease.

Main Results:

• RAS inhibitors demonstrate superior efficacy in reducing proteinuria compared to non-RAS inhibitors at comparable blood pressure control.
• RAS inhibitors slow the progression to ESRD and can improve kidney function, with some cases showing disease regression.
• In diabetic patients, RAS inhibitors delay microalbuminuria onset and progression; ACE inhibitors may reduce cardiovascular mortality.

Conclusions:

• RAS inhibitors are crucial for renoprotective therapy in CKD by reducing proteinuria and slowing disease progression.
• Multimodal approaches, including lifestyle changes and other medications, are often necessary for optimal CKD management.
• Further research is needed to determine the cost-effectiveness of novel renoprotective medications.