Treatment of chronic renal failure – Related resources
03.06.2016 • Sonuncu dəyişiklik 03.03.2014
This article is created and updated by the EBMG Editorial Team
Cochrane reviews
- Antiplatelet therapy appears to lower the risk of myocardial infarction but increase major bleeding in people with chronic kidney disease. It may not reduce total or cardiovascular mortality or stroke .
- Prophylactic nasal mupirocin appears to reduce exit-site/tunnel infection and preoperative intravenous antibiotic prophylaxis reduces early peritonitis in peritoneal dialysis. No antimicrobial intervention appears to reduce the risk of catheter removal or replacement .
- There is no evidence of major advantages from any catheter-related interventions which have been purported to reduce the risk of peritonitis in peritoneal dialysis patients .
- Statins appear to reduce hyperlipidaemia and might possibly reduce cardiovascular events in kidney transplant recipients, but there is insufficient evidence for overall mortality, stroke, kidney function, and toxicity outcomes.
- Statins appear to decrease cholesterol levels in dialysis patients similar to the general population. .
- Statins appear to reduce all-cause and cardiovascular mortality in chronic kidney disease patients who are not requiring dialysis .
- Protein restriction is probably not effective in delaying the progression of chronic kidney disease to end-stage kidney disease in children .
- Low haemoglobin (Hb) concentrations (< 120 g/l) in patients with chronic kidney disease appear not to be associated with increased mortality as compared to higher Hb concentrations (> 133 g/l). Lower Hb targets appear to be associated with an increased risk for seizures but a reduced risk of hypertension .
- Aldosterone antagonists seem to reduce proteinuria in patients with chronic kidney disease who are already on angiotensin converting enzyme inhibitors and angiotensin receptor blockers although the evidence is insufficient and long-term effects on renal outcomes, mortality and safety are unknown. They appear to increase the risk of hyperkalaemia .
- Regular exercise has significant beneficial effects on physical fitness, walking capacity, cardiovascular status, health-related quality of life and some nutritional parameters in adults with chronic kidney disease .
Other evidence summaries
Synthetic membrane, bicarbonate standard duration dialysis is the best method of hemodialysis. Y-set delivery is better than non-Y-set delivery in continuous ambulatory peritoneal dialysis .
Combination of trandolapril and losartan appears to postpone the development of end-stage renal failure compared to either drug alone in patients with non-diabetic renal disease .
Haemodialysis at home may be a cost-effective alternative for selected patients with end-stage renal failure .
Sevelamer appears to decrease coronary and aortic calcification and lower LDL cholesterol compared to calcium salts in patients with end-stage renal disease .
Literature
Clinical practice reviews
- James MT, Hemmelgarn BR, Tonelli M. Early recognition and prevention of chronic kidney disease. Lancet 2010 Apr 10;375(9722):1296-309.
- Abboud H, Henrich WL. Clinical practice. Stage IV chronic kidney disease. N Engl J Med 2010 Jan 7;362(1):56-65.
Other literature
- Tonelli M, Pannu N, Manns B. Oral phosphate binders in patients with kidney failure. N Engl J Med 2010 Apr 8;362(14):1312-24.
- Lewis EJ, Hunsicker LG, Bain RP, Rohde RD. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. The Collaborative Study Group. N Engl J Med 1993 Nov 11;329(20):1456-62.
- Maschio G, Alberti D, Janin G, Locatelli F, Mann JF, Motolese M, Ponticelli C, Ritz E, Zucchelli P. Effect of the angiotensin-converting-enzyme inhibitor benazepril on the progression of chronic renal insufficiency. The Angiotensin-Converting-Enzyme Inhibition in Progressive Renal Insufficiency Study Group. N Engl J Med 1996 Apr 11;334(15):939-45.