Deleting death and dialysis: Conservative care of cardio-vascular risk and kidney function loss in chronic kidney disease (CKD)
Entity
UAM. Departamento de Medicina; Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD)Publisher
MDPIDate
2018-06-12Citation
10.3390/toxins10060237
Toxins 10.6 (2018): Art. 237
ISSN
2072-6651DOI
10.3390/toxins10060237Editor's Version
https://doi.org/10.3390/toxins10060237Subjects
Cardiovascular disease; Chronic kidney disease; CKD; Diet; Lifestyle; Medication; Mortality; Outcomes; Prevention; Uremia; MedicinaRights
© 2018 by the authors. Licensee MDPI, Basel, Switzerland.Abstract
The uremic syndrome, which is the clinical expression of chronic kidney disease (CKD), is a complex amalgam of accelerated aging and organ dysfunctions, whereby cardio-vascular disease plays a capital role. In this narrative review, we offer a summary of the current conservative (medical) treatment options for cardio-vascular and overall morbidity and mortality risk in CKD. Since the progression of CKD is also associated with a higher cardio-vascular risk, we summarize the interventions that may prevent the progression of CKD as well. We pay attention to established therapies, as well as to novel promising options. Approaches that have been considered are not limited to pharmacological approaches but take into account lifestyle measures and diet as well. We took as many randomized controlled hard endpoint outcome trials as possible into account, although observational studies and post hoc analyses were included where appropriate. We also considered health economic aspects. Based on this information, we constructed comprehensive tables summarizing the available therapeutic options and the number and kind of studies (controlled or not, contradictory outcomes or not) with regard to each approach. Our review underscores the scarcity of well-designed large controlled trials in CKD. Nevertheless, based on the controlled and observational data, a therapeutic algorithm can be developed for this complex and multifactorial condition. It is likely that interventions should be aimed at targeting several modifiable factors simultaneously.
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Google Scholar:Vanholder, Raymond
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Van Laecke, Steven
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Glorieux, Griet
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Verbeke, Francis
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Castillo-Rodriguez, Esmeralda
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Ortiz Arduán, Alberto
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