Targets for interventions are shown in Fig. 16-1. Fig. 16-1 Targets for interventions in preventing end-stage kidney disease (ESKD) and cardiovascular

disease (CVD). DM Diabetes mellitus, IGT impaired glucose tolerance,  CKD chronic kidney disease Modification of lifestyles (refer to “treatment of hypertension”). Weight control and stopping with smoking are essential parts of anti-hypertension therapy. Modification of lifestyle may Wortmannin price suppress atherosclerosis, which will result in retarding CKD progression (a). Diet therapy (refer to “Principle of diet therapy of CKD”). Salt restriction is essential as an anti-hypertension therapy. Restriction of dietary protein AZD0156 depending on the CKD stage is assumed to inhibit CKD progression (b). Treatment of

hypertension (refer to “Antihypertensive therapy”). Breakage of a vicious cycle caused by both CKD and hypertension entails strict antihypertensive therapy. Angiotensin converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) play a central part in the therapy, but the co-administration of other antihypertensive agents is also necessary for an optimal blood pressure to be achieved click here (c). Reduction of proteinuria and microalbuminuria. Reduction of urinary protein or microalbumin generally follows lowered blood pressure induced by ACE inhibitor or ARB therapy. The majority of their inhibitory effects on CKD progression rely upon a reduction of urinary protein. Other options include antiplatelet agents and similar drugs which can also suppress about the

urinary protein level. The goal of urinary protein excretion should <0.5 g/g creatinine (d). Treatment of dyslipidemia. Dyslipidemia may be a potential promoter of CKD progression by various mechanisms and is one of the most significant risk factors for CVD. Hence, management of dyslipidemia in CKD is indispensable for suppressing the progression to both ESKD and CVD (e). Treatment of diabetes and glucose intolerance. Strict treatment of diabetes is essential for the suppression of ESKD or the development of CVD (f). Treatment of anemia. Renal anemia appears with progressing CKD stage. Anemia is not only a risk factor for CKD progression but also for CVD. Its treatment is therefore critical for the suppression of both ESKD and CVD (g). Treatment of uremic toxins. An oral adsorbent may be expected to improve uremic symptoms (h). Treatment of an underlying disease of CKD. If a causative disease for CKD is determined, its treatment is primarily recommended (i)."
“Drugs mainly eliminated by the kidney may increase blood concentrations and exert adverse effects more frequently when they are used in cases of reduced kidney function. Dose reduction or prolongation of the interval between administration is necessary in proportion to declining kidney function.