Pharmacological and Nonpharmacological Prevention of End-Stage Renal Disease

RESUMEN

Slowing of the rate of deterioration in renal function in patients with chronic kidney disease (CKD) is feasible; but requires a combination of pharmacological and non pharmaco- logical interventions. Pharmacological interventions of proven efficacy are the following a. Blood pressure control using angiotensin converting enzyme inhibitors and angioten- sin receptor blockers as the first line agents because these drugs have beneficial effects on glomerular haemodynamics and proteinuria in addition to their antihypertensive actions b. Strict blood glucose control in patients with diabetes mellitus c. Use of lipid-lowering agents (statins) d. Pharmacological control of hyperphosphataemia e. Prevention of anaemia with the use of erythropoietin and f. Pharmacological management of the underlying renal disease Non-pharmacological interventions are of equal importance and include maintenance of euvolaemia; prevention or prompt treatment of urinary tract obstruction and infection; hypercalcaemia and hypocalcaemia; and avoidance of nephroto- xins and smoking. The management of CKD is multifaceted and requires diligence and a team approach. Patients and their families should be active members of the team