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Strategies to slow the progression of renal disease
1Department of Medicine, Tufts University School of Medicine, Boston, MA 02111.
Insights
Slowing chronic kidney disease progression is possible with antihypertensive therapy and strict glycemic control. These interventions show promise for diabetic nephropathy and may benefit renal transplant patients.
Area of Science:
- Nephrology
- Clinical Trials
- Pharmacology
Background:
- Chronic kidney disease (CKD) progression is a significant health concern.
- Diabetic nephropathy and renal transplant nephropathy are increasing causes of end-stage renal disease (ESRD).
Purpose of the Study:
- To review recent clinical trial evidence on slowing CKD progression.
- To highlight the protective effects of antihypertensive therapy, glycemic control, and dietary protein restriction.
Main Methods:
- Multicenter clinical trials were analyzed.
- Evidence from studies on antihypertensive agents (including ACE inhibitors), glycemic control, and dietary protein restriction was synthesized.
Main Results:
- Antihypertensive therapy effectively slows CKD progression, potentially through blood pressure reduction or ACE inhibition-specific mechanisms.
- Strict glycemic control ameliorates diabetic nephropathy progression.
- Dietary protein restriction shows some benefit, requiring further study.
- Preliminary data indicate potential benefits for renal transplant nephropathy.
Conclusions:
- Therapies like antihypertensive medications and strict glycemic control can slow the progression of chronic kidney disease.
- Further research is needed to confirm benefits of dietary protein restriction and to understand mechanisms for improved CKD management, including in renal transplant patients.
Abstract:
Recent multicenter clinical trials have confirmed that it is indeed possible to slow the progression of chronic renal disease in patients with diabetic and nondiabetic nephropathy. Antihypertensive therapy is particularly protective in this regard, either due to the lowering of blood pressure or, as is sometimes the case with ACE inhibition, to mechanisms independent of a systemic hemodynamic effect. Similarly, strict glycemic control has now clearly been shown to ameliorate the progression of diabetic nephropathy, while dietary protein restriction appears to have some benefit, although further studies will be required to establish this definitively. Finally, preliminary data suggest that some of these therapies may also slow progression in patients with renal transplant nephropathy, which has unfortunately become an increasingly common cause of ESRD. These encouraging results will hopefully stimulate further efforts to elucidate the mechanisms by which progression occurs, so that even better therapies can be designed.