Chronic renal failure secondary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]

Secondary Prevention

Reduce Progression

  • Protective therapy most effective if initiated early, before Creatinine > 1.5-2.0 mg/dL
    • Treat Hypertension
    • Restrict Dietary Protein
      • Controversial – may decrease intraglomerular pressure
      • Conflicting studies – some show benefit, others do not
      • No significant adverse effects shown in large trial
      • Recommendations
        • No restriction (> 0.8 g/kg/d) if GFR 25-55 mL/min
        • Limit protein to 0.8 g/kg/d if progression or uremic symptoms
        • Limit to 0.6 g/kg/d if severe renal insufficiency (GFR 13-25 mL/min)
      • Close follow-up by dietician given risk of malnutrition in this population
    • Control Blood sugar:
      • Tight control (HbA1c < 7.0, [[Fasting blood sugar 70-120) reduces progression in DM I
      • Unclear if as beneficial in DM II, but potentially helpful

Treat complications

Plan for Renal Replacement Therapy (RRT)

Recent studies have shown no benefits of initiating early dialysis with improved patient survival. [1]However, advanced preparation for dialysis can help avoid complications like poorly functioning fistula for hemodialysis or malfunctioning peritoneal dialysis catheter, sepsis, bleeding and thrombosis.


References

  1. Cooper BA, Branley P, Bulfone L; et al. (2010). "A randomized, controlled trial of early versus late initiation of dialysis". The New England Journal of Medicine. 363 (7): 609–19. doi:10.1056/NEJMoa1000552. PMID 20581422. Unknown parameter |month= ignored (help)


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