Treatment of chronic renal failure
Table of contents
Extract
- The aim of treatment is to slow down the deterioration of renal function and prevent organ complications.
- Patients belonging to risk groups for kidney disease (patients with diabetes or cardiovascular disease, hypertension, obesity or family history of kidney disease) should be screened (plasma creatinine and chemical urinalysis and/or urine albumin/creatinine ratio).
- The metabolic sequelae of renal failure and the risk factors for atherosclerosis should be identified and treated. The risk of cardiovascular disease increases as soon as there is proteinuria even if renal function is still normal.
- The number of patients with renal failure is increasing, particularly because type 2 diabetes is becoming more common and the population is ageing.
- It is important to start treatment as soon as possible.
- In an elderly person, eGFR may be decreased merely because of advanced age even though the plasma creatinine concentration is still completely normal. As a solitary finding, this is not a sign of renal disease.
Linked evidence summaries
- ACE inhibitors and angiotensin II receptor blockers lower urinary protein excretion and are renoprotective.A
- ACE inhibitors and angiotensin receptor blockers are more effective than other antihypertensive agents in reducing the development of end-stage non-diabetic renal disease.A
- The effects of aldosterone antagonists when added to angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers (or both) on the risks of death, major cardiovascular events, and kidney failure in people with proteinuric CKD are uncertain.D
- Intensive glycaemic control is effective in reducing the risk of microvascular complications in people with type 1 and type 2 diabetes.A
- There is insufficient evidence on the effect of protein restriction for diabetic kidney disease.D
- SGLT-2 inhibitors and GLP-1 agonists are effective for glucose-lowering and cardiovascular events in persons with diabetes and chronic kidney disease compared with placebo. SGLT-2 inhibitors reduce the progression of renal disease in patients with or without diabetes.A↑↑
- Statins reduce all-cause and cardiovascular mortality in chronic kidney disease patients compared with controls. Especially high-intensity statin therapy may modestly reduce proteinuria and rate of eGFR decline.A
- Salt reduction appears to be effective to reduce blood pressure and appears to be renoprotective in people with chronic kidney disease compared to normal diet in short term.B
- Potassium binders may be effective for chronic hyperkalaemia in people with chronic kidney disease compared with placebo.C
- Treatment with rHu EPO in pre-dialysis patients corrects anaemia and avoids the requirement for blood transfusions. However, targeting haemoglobin concentrations over 120g/l with rHu EPO when treating anaemic patients with chronic kidney disease appears to increase all-cause mortality.A
- Parenteral iron therapy may be effective for increasing haemoglobin, ferritin and transferrin saturation in chronic kidney disease compared to oral iron. However, it may not decrease mortality and other patient important outcomes.C
- Phosphate binders (calcium-based agents, sevelamer, lanthanum) may reduce serum phosphorus levels in chronic kidney disease compared with placebo. However, their use may not be effective for reducing all-cause mortality.C
- Calcimimetic treatment of secondary hyperparathyroidism in end-stage chronic kidney disease appears to be effective for improving biochemical parameters (S-Ca, S-Ph, S-PTH), but appears not to reduce mortality.B
Search terms
Acidosis, Aminoglycosides, Anemia, Angiotensin II Type 1 Receptor Blockers, Angiotensin-Converting Enzyme Inhibitors, Anti-Inflammatory Agents, Bicarbonates, Calcitriol, Calcium, Calcium Carbonate, Captopril, Contrast Media, Creatinine, Dairy Products, Diabetes Mellitus, Diabetic Nephropathies, Diet Therapy, Diet, Protein-Restricted, Diuretics, Electrolytes, Enalapril, Endocrinology, Erythropoietin, Ferritins, GFR, Glomerular filtration rate, Gold, Hemoglobins, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hyperkalemia, Hyperlipidemias, Hyperparathyroidism, Hyperparathyroidism, Secondary, Hypertension, Hypocalcemia, I10, Infection, Internal medicine, Kidney Failure, Kidney Failure, Chronic, Lisinopril, N17-N19, N18*, N18.9, N19, N25.8, Nephrology, Perindopril, Phosphates, Potassium, Ramipril, Renal Artery Obstruction, Renal Insufficiency, Renal Insufficiency, Chronic, Smoking, Sodium, Sodium Bicarbonate, Thiazides, Transferrin, Uremia, Vitamin D, base excess, calcium-phosphate product, electrolyte balance, fibrate, hyperphosphatemia, ionized calcium, loop diuretics, phosphate restriction, renal anemia, transferrin saturation, x-ray contrast examination