Advances in chronic kidney disease
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Adv Chronic Kidney Dis · Jan 2016
ReviewConservative Care of the Elderly CKD Patient: A Practical Guide.
Palliative care is a branch of medicine dedicated to the relief of symptoms experienced during the course of illness. Renal palliative medicine or kidney supportive care is an evolving branch of nephrology, which incorporates the principles of palliative care into the care of CKD and ESRD (dialysis, transplant, and conservatively managed) patients. Conservative (non-dialytic) management is a legitimate option for frail, elderly CKD patients in whom dialysis may not lead to an improvement in quality or duration of life. ⋯ Symptoms appear to increase as the patient nears death, and this must be anticipated. Recommendations for management are discussed in the article. Hospice care should be offered to all patients who are expected to die within the next 6 months, and supportive care should be provided to all CKD patients managed conservatively or with dialysis.
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Adv Chronic Kidney Dis · Sep 2015
ReviewChronic Kidney Disease and Related Long-Term Complications After Liver Transplantation.
Liver transplantation is the standard of care for patients with decompensated cirrhosis. Liver transplantation recipients have excellent short-term and long-term outcomes including patient and graft survival. ⋯ Occurrence of Stage 4 chronic kidney disease and end stage renal disease substantially increases the risk of post-transplant deaths. Because majority of late post-transplant mortality is due to nonhepatic post-transplant comorbidities, personalized care directed toward risk factor modification may further improve post-transplant survival.
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Adv Chronic Kidney Dis · Mar 2015
ReviewHitting the mark: blood pressure targets and agents in those with prevalent cardiovascular disease and heart failure.
Blood pressure (BP) is one of the key modifiable risk factors for cardiovascular disease (CVD) both in primary and secondary prevention of disease. In this review, we discuss BP treatment in prevalent CVD and heart failure. ⋯ The potential adverse effects of overtreatment of BP are also discussed. BP targets for those with CVD should generally be less than 140/90 mm Hg but require individualization of therapy for any further reduction based on the clinical setting.
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Adv Chronic Kidney Dis · Nov 2014
ReviewApparent treatment-resistant hypertension and chronic kidney disease: another cardiovascular-renal syndrome?
To identify patients at increased risk of cardiovascular (CV) outcomes, apparent treatment-resistant hypertension (aTRH) is defined as having a blood pressure above goal despite the use of 3 or more antihypertensive therapies of different classes at maximally tolerated doses, ideally including a diuretic. Recent epidemiologic studies in selected populations estimated the prevalence of aTRH as 10% to 15% among patients with hypertension and that aTRH is associated with elevated risk of CV and renal outcomes. Additionally, aTRH and CKD are associated. ⋯ Although diuretics form the basis of therapy in aTRH, pathophysiologic and clinical data suggest an important role for aldosterone antagonism. Interventional techniques, such as renal denervation and carotid baroreceptor activation, modulate the sympathetic nervous system and are currently in phase III trials for the treatment of aTRH. These technologies are as yet unproven and have not been investigated in relationship to CV outcomes or in patients with CKD.
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Adv Chronic Kidney Dis · Sep 2014
ReviewThe treatment of idiopathic focal segmental glomerulosclerosis in adults.
Focal segmental glomerulosclerosis (FSGS) is the histologic end point of many disease processes that affect the kidney. Clinically, adults with FSGS present with proteinuria that may be accompanied by the nephrotic syndrome. Once identifiable (secondary) causes are excluded, the diagnosis of idiopathic FSGS, a challenging glomerular disease to understand and manage, is made. ⋯ However, steroid resistance is common and portends an increased risk of long-term decline in kidney function and end-stage kidney disease in these patients compared with responders. Multiple other immunosuppression regimens have been used in steroid-resistant FSGS, some of which have been studied in randomized controlled trials. Here, we review the data on the treatment for idiopathic FSGS in adults.