Kidney Disease Care 2.0

Chronic kidney disease management updated in a review of current research

(RxWiki News) Chronic kidney disease puts patients at risk of many other health problems. With that in mind, it is important for doctors and patients to know how to prevent and treat these risks.

Researchers summarized the recent evidence on the management of chronic kidney disease.

The review addresses ways to treat a number of conditions linked to kidney disease, including diabetes, high blood pressure and high cholesterol among others.

"Follow your doctor's treatments to prevent complications."

"Patients with chronic kidney disease are more likely to die of cardiovascular disease than to require dialysis," said Josette A. Rivera, MD, of the University of California San Fransico, and colleagues in background information of their article.

Thus, reducing the risk of complications and death in patients with kidney disease requires the management of cardiovascular disease risk factors, they said.

Give these higher risks, "it is important to identify and treat related risk factors," the researchers said. "However, there is growing uncertainty about the benefits of some recommended treatment targets," they said.

Through looking at the current evidence on complications of kidney disease, Dr. Rivera and colleagues summarized treatments of complications and certain controversies surrounding those treatments.

In their review, the researchers addressed the management of:

  • Diabetes
  • Proteinuria - or high levels of protein in the urine, which can be a sign of kidney damage
  • Hypertension - or high blood pressure
  • Dyslipidemia - or high cholesterol levels
  • Anemia - a lack of healthy red blood cells, which provide oxygen to body tissues
  • Contrast-induced nephropathy - a condition in which levels of creatinine (a measure of kidney function) rise more than 25 percent after X-ray dye injection

Topics in the review included:

  • Blood sugar targets for kidney disease patients with diabetes should be determined individually for each patient. The National Kidney Foundation recommends that patients with diabetes aim for an A1C level (a measure of blood sugar over time) of 7 percent. However, there is no evidence that this blood sugar target reduces cardiovascular problems or the risk of end-stage renal disease (complete or near-complete kidney failure). Dr. Rivera and colleagues recommended that higher targets may work for older adults and those with a limited life expectancy - a group in which the risks of intense blood sugar control may outweigh the benefits.
  • There is controversy surrounding optimal blood pressure goals. The researchers recommended that patients do not use angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) at the same time to lower blood pressure. Taking these two drugs simultaneously could lead to worsening kidney function. More research is needed to see which blood pressure goals are best for for patients with different levels of proteinuria.
  • Treating high cholesterol may reduce the risk of cardiovascular problems in kidney disease patients. However, treating high cholesterol does not slow the progression of chronic kidney disease. "As in the general population, it is important to consider life expectancy and competing health concerns when deciding [cholesterol-lowering] therapy," the researchers said.
  • There is also controversy surrounding the treatment of anemia in kidney disease patients - particularly treatment involving erythropoiesis- stimulating agents (ESAs) and targets for levels of hemoglobin (a protein in red blood cells that carries oxygen). Studies have shown that the use of ESAs to boost hemoglobin may increase the risk of complications and death.
  • Even though patients with kidney disease are at risk of complications and death from the use of intravenous contrast agents, studies have shown that isotonic intravenous hydration with sodium bicarbonate or saline can prevent contrast-induced nephropathy.

The research article by Dr. Rivera and colleagues - entitled "Update on the Management of Chronic Kidney Disease - was published October 15 in American Family Physician.

Review Date: 
October 17, 2012