International Urology and Nephrology

, Volume 46, Issue 11, pp 2167–2174 | Cite as

Preventing the progression of chronic kidney disease: two case reports and review of the literature

  • Muhammad R. Toor
  • Anjali Singla
  • Jin K. Kim
  • Xenia Sumin
  • Maria V. DeVita
  • Michael F. Michelis
Nephrology - Review

Abstract

A variety of therapeutic modalities are available to alter the abnormalities seen in patients with chronic kidney disease (CKD). A comprehensive plan can now be developed to slow the progression of CKD. Two clinical cases of delay in the need for renal replacement therapy are described. This delay was achieved by using recognized recommendations for optimal diabetes therapy (HbA1c target 7 %), goals for blood pressure levels, reduction of proteinuria, and the proper use of ACEI/ARB therapies. Recent recommendations include BP <140/90 mmHg for patients <60 years old and <150/90 mmHg for older patients unless they have CKD or diabetes. Limits on dietary sodium and protein intake and body weight reduction will decrease proteinuria. Proper treatment for elevated serum phosphorous and parathyroid hormone levels is now appreciated as well as the benefits of therapy for dyslipidemias and anemia. Concerns regarding unfavorable outcomes with excess ESA therapy have led to hemoglobin goals in the 10–12 g/dL range. Finally, new therapeutic considerations for the treatment of acidosis and hyperuricemia are presented with data available to suggest that increasing serum bicarbonate to >22 mmol/L is beneficial, while serum uric acid therapeutic goals are still uncertain. Also, two as yet insufficiently understood approaches to altering the course of CKD (FGF-23 level reduction and balancing gut microbiota) are noted.

Keywords

Chronic kidney disease Hypertension and chronic kidney disease Proteinuria Parathyroid hormone Metabolic acidosis Hyperuricemia 

References

  1. 1.
    Lewis EJ, Hunsicker LG, Bain RP, Rohde RD (1993) The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. The collaborative study group. N Engl J Med 329(20):1456–1462PubMedCrossRefGoogle Scholar
  2. 2.
    Banach M, Serban C, Aronow WS, Rysz J, Dragan S, Lerma EV, Apetrii M, Covic A (2014) Lipid, blood pressure and kidney update 2013. Int Urol Nephrol 46(5):947–961. doi:10.1007/s11255-014-0657-6 PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Altemtam N, Russell J, El Nahas M (2012) A study of the natural history of diabetic kidney disease (DKD). Nephrol Dial Transplant 27(5):1847–1854. doi:10.1093/ndt/gfr561 PubMedCrossRefGoogle Scholar
  4. 4.
    The Diabetes Control and Complications Trial Research Group et al (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329(14):977–986CrossRefGoogle Scholar
  5. 5.
    Kidney Disease Improving Global Outcomes (KDIGO) CKD Work Group: KDIGO (2012) Clinical practice guideline for the evaluation and management of chronic kidney disease (2013). Kidney Int Suppl 3:1–150Google Scholar
  6. 6.
    Bakris GL, Williams M, Dworkin L, Elliott WJ, Epstein M, Toto R, Tuttle K, Douglas J, Hsueh W, Sowers J (2000) Preserving renal function in adults with hypertension and diabetes: a consensus approach. Am J Kidney Dis 36(3):646–661PubMedCrossRefGoogle Scholar
  7. 7.
    Sarnak MJ, Greene T, Wang X, Beck G, Kusek JW, Collins AJ, Levey AS (2005) The effect of a lower target blood pressure on the progression of kidney disease: long-term follow-up of the modification of diet in renal disease study. Ann Intern Med 142(5):342–351PubMedCrossRefGoogle Scholar
  8. 8.
    Wright JT Jr, Bakris G, Greene T, Agodoa LY, Appel LJ, Charleston J, Cheek D, Douglas-Baltimore JG, Gassman J, Glassock R, Hebert L, Jamerson K, Lewis J, Phillips RA, Toto RD, Middleton JP, Rostand SG, African American Study of Kidney Disease and Hypertension Study Group (2002) Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA 288(19):2421–2431PubMedCrossRefGoogle Scholar
  9. 9.
    James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith SC, Svetkey LP, Taler SJ, Townsend RR, Wright JT Jr, Narva AS, Ortiz E (2014) 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8) JAMA 311(5):507-520. doi:10.1001/jama.2013.284427
  10. 10.
    Yu W, Luying S, Haiyan W, Xiaomei L (2012) Importance and benefits of dietary sodium restriction in the management of chronic kidney disease patients: experience from a single Chinese center. Int Urol Nephrol 44(2):549–556. doi:10.1007/s11255-011-9986-x PubMedCrossRefGoogle Scholar
  11. 11.
    Aburto NJ, Ziolkovska A, Hooper L, Elliot P, Cappuccio FP, Meerpohl JJ (2013) Effect of lower sodium intake on health: systematic review and meta-analyses. BMJ 346:f1326. doi:10.1136/bmj.f1326 PubMedCrossRefGoogle Scholar
  12. 12.
    Atkins RC, Briganti EM, Lewis JB, Hunsicker LG, Braden G, Champion de Crespigny PJ, DeFerrari G, Drury P, Locatelli F, Wiegmann TB, Lewis EJ (2005) Proteinuria reduction and progression to renal failure in patients with type 2 diabetes mellitus and overt nephropathy. Am J Kidney Dis 45(2):281–287PubMedCrossRefGoogle Scholar
  13. 13.
    The GISEN Group (Gruppo Italiano di Studi Epidemiologici in Nefrologia) (1997) Randomized 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 349(9069):1857–1863CrossRefGoogle Scholar
  14. 14.
    Siamopoulos KC, Kalaitzidis RG (2008) Inhibition of the renin–angiotensin system and chronic kidney disease. Int Urol Nephrol 40(4):1015–1025. doi:10.1007/s11255-008-9424-x PubMedCrossRefGoogle Scholar
  15. 15.
    Brenner BM, Cooper ME, DeZeeuw D, Keane WF, Mitch WE, Parving HH, Remuzzi G, Snapinn SM, Zhang Z, Shahinfar S, RENAAL Study Investigators (2001) Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 345(12):861–869PubMedCrossRefGoogle Scholar
  16. 16.
    Fried LF, Emanuele N, Zhang JH, Brophy M, Conner TA, Duckworth W, Leehey DJ, McCullough PA, O’Connor T, Palevsky PM, Reilly RF, Seliger SL, Warren SR, Watnick S, Peduzzi P, Guarino P, VANEPHRON-D Investigators (2013) Combined angiotensin inhibition for the treatment of diabetic nephropathy. N Engl J Med 369(20):1892–1903. doi:10.1056/NEJMoa1303154 PubMedCrossRefGoogle Scholar
  17. 17.
    Kalaitzidis RG, Siamopoulos KC (2011) The role of obesity in kidney disease: recent findings and potential mechanisms. Int Urol Nephrol 43(3):771–784. doi:10.1007/s11255-011-9974-1 PubMedCrossRefGoogle Scholar
  18. 18.
    Ritz E, Koleganova N (2009) Obesity and chronic kidney disease. Semin Nephrol 29(5):504–511. doi:10.1016/j.semnephrol.2009.06.007 PubMedCrossRefGoogle Scholar
  19. 19.
    Vaziri ND (2013) Role of dyslipidemia in impairment of energy metabolism, oxidative stress, inflammation and cardiovascular disease in chronic kidney disease. Clin Exp Nephrol. Epub ahead of print 24 Aug 2013Google Scholar
  20. 20.
    Siamopoulos KC, Gouva C, Katopodis KP, Tzallas C, Nikolopoulos P, Papavasiliou EC, Tselepis AD (2006) Long-term treatment with EPO increases serum levels of high-density lipoprotein in patients with CKD. Am J Kidney Dis 48(2):242–249. doi:10.1053/j.ajkd.2006.04.071 PubMedCrossRefGoogle Scholar
  21. 21.
    Bianchi S, Bigazzi R, Caiazza A, Campese VM (2003) A controlled, prospective study of the effects of atrovastatin on proteinuria and progression of kidney disease. Am J Kidney Dis 41(3):565–570PubMedCrossRefGoogle Scholar
  22. 22.
    Baigent C, Landray MJ, Reith C et al (2011) The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomized placebo-controlled trial. Lancet 377(9784):2181–2192. doi:10.1016/S0140-6736(11)60739-3 PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    Ramezani A, Raj DS (2014) The gut microbiome, kidney disease, and targeted interventions. J Am Soc Nephrol 25(4):657–670. doi:10.1681/ASN.2013080905 PubMedCrossRefGoogle Scholar
  24. 24.
    Rossert J, Froissart M (2006) Role of anemia in progression of chronic kidney disease. Semin Nephrol 26(4):283–289PubMedCrossRefGoogle Scholar
  25. 25.
    KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease (2012) Kidney International Supplements 2(4):283–287Google Scholar
  26. 26.
    Gouva C, Nikolopoulos P, Ioannidis JPA, Siamopoulos KC (2004) Treating anemia early in renal failure patients slows the decline of renal function: a randomized controlled trial. Kidney Int 66(2):753–760. doi:10.1111/j.1523-1755.2004.00797.x PubMedCrossRefGoogle Scholar
  27. 27.
    Pfeffer MA, Burdmann EA, Chen CY, Cooper ME, de Zeeuw D, Eckardt KU, Feyzi JM, Ivanovich P, Kewalramani R, Levey AS, Lewis EF, McGill JB, McMurray JJ, Parfrey P, Parving HH, Remuzzi G, Singh AK, Solomon SD, Toto R, TREAT Investigators (2009) A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease. N Engl J Med 361(21):2019–2032. doi:10.1056/NEJMoa0907845 PubMedCrossRefGoogle Scholar
  28. 28.
    Schwarz U, Amann K, Orth SR, Simonaviciene A, Wessels S, Ritz E (1998) Effect of 1,25 (OH)2 vitamin D3 on glomerulosclerosis in subtotally nephrectomized rats. Kidney Int 53(6):1696–1705PubMedCrossRefGoogle Scholar
  29. 29.
    Schwarz S, Trivedi BK, Kalantar-Zadeh K, Kovesdy CP (2006) Association of disorders in mineral metabolism with progression of chronic kidney disease. Clin J Am Soc Nephrol 1(4):825–831PubMedCrossRefGoogle Scholar
  30. 30.
    Jamal SA, Vandermeer B, Raggi P, Mendelssohn DC, Chatterley T, Dorgan M, Lok CE, Fitchett D, Tsuyuki RT (2013) Effect of calcium-based versus non-calcium-based phosphate binders on mortality in patients with chronic kidney disease: an updated systematic review and meta-analysis. Lancet 382(9900):1268–1277. doi:10.1016/S0140-6736(13)60897-1 PubMedCrossRefGoogle Scholar
  31. 31.
    Martin KJ, González EA (2007) Metabolic bone disease in chronic kidney disease. J Am Soc Nephrol 18(3):875–885PubMedCrossRefGoogle Scholar
  32. 32.
    Zhang Z, Zhang Y, Ning G, Deb DK, Kong J, Li YC (2008) Combination therapy with AT1 blocker and vitamin D analog markedly ameliorates diabetic nephropathy: blockade of compensatory renin increase. Proc Natl Acad Sci USA 105(41):15896–15901. doi:10.1073/pnas.0803751105 PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Molina P, Górriz JL, Molina MD, Peris A, Beltrán S, Kanter J, Escudero V, Romero R, Pallardó LM (2014) The effect of cholecalciferol for lowering albuminuria in chronic kidney disease: a prospective controlled study. Nephrol Dial Transplant 29(1):97–109PubMedCrossRefGoogle Scholar
  34. 34.
    Maizel J, Six I, Dupont S, Secq E, Dehedin B, Barreto FC, Benchitrit J, Poirot S, Slama M, Tribouilloy C, Choukroun G, Maziere JC, Drukee TB, Massy ZA (2013) Effects of sevelamer treatment on cardiovascular abnormalities in mice with chronic renal failure. Kidney Int 84(3):491–500. doi:10.1038/ki.2013 PubMedCrossRefGoogle Scholar
  35. 35.
    Kovesdy CP (2012) Metabolic acidosis and kidney disease: does bicarbonate therapy slow the progression of CKD? Nephrol Dial Transplant 27(8):3056–3062. doi:10.1093/ndt/gfs291 PubMedCrossRefGoogle Scholar
  36. 36.
    Navaneethan SD, Schold JD, Arrigain S, Jolly SE, Wehbe E, Raina R, Simon JF, Srinivas TR, Jain A, Schreiber MJ Jr, Nally JV Jr (2011) Serum bicarbonate and mortality in stage 3 and stage 4 chronic kidney disease. Clin J Am Soc Nephrol 6(10):2395–2402. doi:10.2215/CJN.03730411 PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Susantitaphong P, Sewaralthahab K, Balk EM, Jaber BL, Madias NE (2012) Short- and long-term effects of alkali therapy in chronic kidney disease: a systematic review. Am J Nephrol 35(6):540–547. doi:10.1159/000339329 PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Shah SN, Abramowitz M, Hostetter TH, Melamed ML (2009) Serum bicarbonate levels and the progression of kidney disease: a cohort study. Am J Kidney Dis 54(2):270–277. doi:10.1053/j.ajkd.2009.02.014 PubMedCrossRefGoogle Scholar
  39. 39.
    Domrongkitchaiporn S, Sritara P, Kitiyakara C, Stitchantrankul W, Krittaphol V, Lolekha P, Cheepudomwit S, Yipintsoi T (2005) Risk factors for development of decreased kidney function in a southeast Asian population: a 12-year cohort study. J Am Soc Nephrol 16(3):791–799PubMedCrossRefGoogle Scholar
  40. 40.
    Siu YP, Leung KT, Tong MK, Kwan TH (2006) Use of allopurinol in slowing the progression of renal disease through its ability to lower serum uric acid level. Am J Kidney Dis 47(1):51–59PubMedCrossRefGoogle Scholar
  41. 41.
    Hsu CY, Iribarren C, McCulloch CE, Darbinian J, Go AS (2009) Risk factors for end-stage renal disease: 25-year follow up. Arch Intern Med 169(4):342–350. doi:10.1001/archinternmed.2008.605 PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Goicoechea M, de Vinuesa SG, Verdalles U, Ruiz-Caro C, Ampuero J, Rincon A, Arroyo D, Luno J (2010) Effect of allopurinol in chronic kidney disease progression and cardiovascular risk. Clin J Am Soc Neprhol 5:1388–1393. doi:10.2215/CJN.01580210 CrossRefGoogle Scholar
  43. 43.
    Kanbay M, Huddam B, Azak A, Solak Y, Kadioglu GK, Kirbas I, Duranay M, Covic A, Johnson RJ (2011) A randomized study of allopurinol on endothelial function and estimated glomerular filtration rate in asymptomatic hyperuricemic subjects with normal renal function. Clin J Am Soc Nephrol 6(8):1887–1994. doi:10.2215/CJN.11451210 PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Miao Y, Ottenbros SA, Laverman GD, Brenner BM, Cooper ME, Parving HH, Grobbee DE, Shahinfar S, de Zeeuw D, Lambers Heerspink HJ (2011) Effect of a reduction in uric acid on renal outcomes during losartan treatment: a post hoc analysis of the reduction of endpoints in non-insulin dependent diabetes mellitus with the Angiotensin II Antagonist LosartanTrial. Hypertension 58(1):2–7. doi:10.1161/HYPERTENSIONAHA.111.171488 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  • Muhammad R. Toor
    • 1
  • Anjali Singla
    • 1
  • Jin K. Kim
    • 1
  • Xenia Sumin
    • 1
  • Maria V. DeVita
    • 1
  • Michael F. Michelis
    • 1
  1. 1.Lenox Hill HospitalNew YorkUSA

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