(renoprotective (end-stage renal disease, ESRD) therapies) (JAMA)

Size: px

Start display at page:

Download "(renoprotective (end-stage renal disease, ESRD) therapies) (JAMA)"

Meryl MargaretMargaret Barrett
5 years ago
Views:

1 [1], 1., (renoprotective (end-stage renal disease, ESRD) therapies) (JAMA) (multiple risk (renal replacement therapy, RRT) factors intervention treatment MRFIT) [2] ( 1) % (ESRD) ( ) ( 1) 2001 (120 ml/min) (1 ml/min) (90 ml/min) (3 ml/min) ( ) ( ) 1 136

2 (Renoprotective Therapies) (glomerulosclerosis) [5-8] (Hebert (Scr 2.5 mg/dl Ccr 30 ml/min) LA) 2001 (K.I.) ACEIs [3] meq (MRFIT) (Levels I III) ( 1) Kayexalate Kalimate 1. (MRFIT) (Level 1) (ACEIs-Angiotensin converting enzyme inhibitors, ACEIs) (Cr 1.5 mg/dl) (renal progression) 3. (HbA1C %) 4. (Level 2) (NEJM) /75 (mmhg) /85 mmhg (Level 3) 1. (homocysteine) 2. (Nonsteroidal antiinflammatory drugs) [4] ( ) 3. (hyperinsulinemia) 4. (antioxidants) 5. (ACEIs) 6. (Calcium channel antagonists 7. nondihydropyridine non-dhp, CCBs) 8. (BP 125/75 mmhg) 9. Angiotensin ( 1 g/day) II receptor antagonists, AIIAs Angiotensin 2. (ACEIs) receptor blockers, ARBs)

3 6. (RAA system-renin-angiotensin-aldosterone system) (AIIAs ARBs) (RENAAL IRMA2 IDNT) [9-11] 7. ( ) 10 g/dl ACEIs (DOQI ) ARBs mg/dl [17] [12-15] 3. [18-19] (hyperfiltration) (left ventricular hypertrophy LVH) 70% (rhu-epo) (incipent nephropathy) (microalbuminuria) (HbA 1C ) (chronic hypoxia therapy) ( ( 6.5 7%) [15-16] ) [20] 4. [21-22] (Ccr 20 ml/min ) (CREATE ) 0.6 ( ) 3 [4] 5 9. (homocysteine) 5. (Apo B) (2 15 ) B (NSAIDs) HMG (statins) (fibric acids) (rhabdomyolysis) 11. (hyperinsulinemia) X B 6 138

4 (syndrome X) Thiazolidinediones (Avandia ) 12. (antioxidants) (not-indicated) 1. (steroid-re- minimal change disease) (Vit. C 200 mg)sponsive (Vit. E) ( ) 3. ( ) (cyst growth) 4. (thin basement membrane disease) 14. (Vit. D) 5. ( mg/dl) ( 1 g/day) 70 ( 55) [ 3,23] (aspirin) 81 (HOT study) [24] ACEIs 16. (MRFIT) 17. (ARBs) [11-13] Levin A: Identification of patients and risk factors in chronic kidney disease: evaluating risk factors and therapeutic strategies. Nephrol Dial Transplant 2001; 16 (suppl 7): Anonymous: Multiple risk factor intervention trial (MRFIT): Risk factor changes and mortality results. JAMA 1982; 248:

5 3. Hebert LA, Wiber MA, Falksman ME: Renoprotection: one or many therapies. Kidney Int 2001; 59: Klahr S, Levey A, Beck J, et al: The effects of dietary protein restriction and blood pressure control on the progression of chronic disease. N Engl J Med 1994; 330: Dasgupta I, Madeley RJ, Pringle MAL, Savill J, Burden RP: Management of hypertension in patients developing endstage renal failure. Q J Med 1999; 92: Schwenger V, Ritz E: Audit of antihypertensive treatment in patients with renal failure. Nephrol Dial Transplant 1998; 13: Lewis EJ, Hunsicker LG, Bain RP, Rohde RD for the Collaborative Study Group: The effect of angiotensin-convertingenzyme inhibition on diabetic nephropathy. N Engl J Med 1993; 329: Russo D, Pisan A, Balletta M, et al: Additive antiproteinuric effect of converting enzyme inhibitor and losartan in normotensive patients with IgA nephropathy. Am J Kidney Dis 1999; 33: The GISEN Group: Randomised placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric non-diabetic nephropathy. Lancet 1997; 349: Muirhead N: The rational for early management of chronic renal insufficiency. Nephrol Dial Transplant 2001; 10(suppl 7): Brenner BM, Cooper ME, de Zeeuw D, et al: Effects of losartan on renal and cardiovascular outcomes in patients with type II diabetes and nephropathy (RENAAL Study). New Engl J Med 2001; 345: Lewis EJ, Hunsicker LG, Clarke WR, et al: Renoprotective effect of ARB - Irbesartan in patients with nephropathy due to type 2 diabetes (IRMA2 Study). New Engl J Med 2001; 345: Parving HH, Lehnert H, Brochner-Mortensen J, et al: The effect of Irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes (IDNT study). New Engl J Med 2001; 345: Russo D, Minutolo R, Risani A, et al: Coadministration of losartan and enalapril exerts additive antiproteinuric effect in IgA nephropathy. Am J Kidney Dis 2001; 38: Remuzzi G, Schieppati A, Ruggenenti P: Nephropathy in Patients with Type 2 Diabetes. N Engl J Med 2002; 346: American Diabetes Association: Standards of medical care for patients with diabetes mellitus. Diabetes Care 2002; 25: DOQI (Dialysis Outcomes Quality Initiative) guidelines, National Kidney Foundation Obrador GT, Ruthazer R, Arora P, et al: Prevalence of and factors associated with suboptimal care before initiation of dialysis in the United States. J Am Soc Nephrol 1999; 10: Fink JC, Blahut S, Reddy M, Light PD: Use of erythropoietin before the initiation of dialysis and its impact on mortality. Am J Kidney Dis 2001; 37: Fine L, Orphanides C, Norman J: Progressive renal disease: the chronic hypoxia hypothesis. Kidney Int 1998; 53: S Jungers P, Choukroun G, Oualim Z, Robino C, Nguyen AA, Man NK: Beneficial influence of recombinant human erythropoietin therapy on the rate of progression of chronic renal failure in predialysis patients. Nephrol Dial Transplant 2001; 16: Kuriyama S, Tomonari H, Yoshida H, et al: Reversal of anemia by erythropoietin therapy retards the progresson of chronic renal failure, especially in nondiabetic patients. Nephron 1997; 77: Katrin Uhlig, Mark JS, Ajay KS, et al: New approaches to the treatment of calcium and phosphorus abnormalities in patients on hemodialysis. Curr Opin Nephrol Hypertens 2001; 10: Hansson L, Zanchetti A, Carruthers SG, et al: Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet 1998; 351:

RENAAL, IRMA-2 and IDNT. Three featured trials linking a disease spectrum IDNT RENAAL. Death IRMA 2

RENAAL, IRMA-2 and IDNT. Three featured trials linking a disease spectrum IDNT RENAAL. Death IRMA 2 Treatment of Diabetic Nephropathy and Proteinuria Background End stage renal disease is a major cause of death and disability among diabetics BP reduction is important to slow the progression of diabetic