What next after RAAS blockade?
At the current time, we only have RAAS blockade and hypertension control to slow progression to ESRD. What mechanisms should be targeted to slow progression (loss of GFR) in diabetic nephropathy?
Browse Ideas with tag 'progression':
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This idea is active.DIABETIC NEPHROPATHY »11 comments for Idea: What next after RAAS blockade?
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This idea is active.CKD »
How does diet affect progression of CKD?
Diets may impact CKD progression in several ways. A vegetarian diet lowers colon-derived uremic toxins such as indoxyl sulfate and p-cresol (Patel, J Am Soc Nephrol (Nov) 19:488A 2008). Diets high in advanced glycosylated end products are associated with evidence of glycation of body tissues. Phosphate restriction in CKD lowers serum FGF levels. A study is proposed using a 2 x 2 factorial design to study progression ...more »
7 comments for Idea: How does diet affect progression of CKD?Diets may impact CKD progression in several ways. A vegetarian diet lowers colon-derived uremic toxins such as indoxyl sulfate and p-cresol (Patel, J Am Soc Nephrol (Nov) 19:488A 2008). Diets high in advanced glycosylated end products are associated with evidence of glycation of body tissues. Phosphate restriction in CKD lowers serum FGF levels. A study is proposed using a 2 x 2 factorial design to study progression of CKD in patients eating a vegetarian vs. meat-based diet, with or without restriction of phosphate and high-AGE foods. Outcomes would be 50% reduction of cystatin-estimated GFR or progression to dialysis/transplantation.
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This idea is active.CKD »
Reducing uric acid levels to slow CKD progression.
3 comments for Idea: Reducing uric acid levels to slow CKD progression.Recent single-center randomized trials suggest reducing uric acid levels to be simultaneously renoprotective and cardioprotective, even without the presence of gout. Risk reductions on the order of 50% have been reported.
These results need validation in larger, multi-center trials, as well as determining optimal targets and treatment guidelines.
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This idea is active.CKD »
What is the optimum dietary sodium intake in CKD?
A lower Na diet has been suggested for CKD patients, and may help reduce proteinuria, but impact on progression has not been proven, and in heart failure, the role of a low sodium diet is being questioned (see Rothberg et al, J Gen Intern Med 25(10):1136–7, 2010). Proposed would be a randomized study in proteinuric diabetic CKD patients with target dietary Na of 1.5 vs. 3.0 g/day, with endpoints being 50% reduction in ...more »
Add your comment for Idea: What is the optimum dietary sodium intake in CKD?A lower Na diet has been suggested for CKD patients, and may help reduce proteinuria, but impact on progression has not been proven, and in heart failure, the role of a low sodium diet is being questioned (see Rothberg et al, J Gen Intern Med 25(10):1136–7, 2010).
Proposed would be a randomized study in proteinuric diabetic CKD patients with target dietary Na of 1.5 vs. 3.0 g/day, with endpoints being 50% reduction in estimated cystatin GFR or dialysis/transplantation.
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This idea is active.NKDEP-Translation »
Multifactorial intervention to stop progressive CKD
Patients with progressive CKD (diabetic and non-diabetic) benefit from aggressive treatment that improves control of its antecedents, such as poor control of blood pressure, blood glucose, lipid profiles, etc. Some multifactorial interventions have been effective (most notably, the Steno2 Study) but none have been widely translated to populations or conducted in a diverse US population. Telehealth approaches may help ...more »
1 comment for Idea: Multifactorial intervention to stop progressive CKDPatients with progressive CKD (diabetic and non-diabetic) benefit from aggressive treatment that improves control of its antecedents, such as poor control of blood pressure, blood glucose, lipid profiles, etc. Some multifactorial interventions have been effective (most notably, the Steno2 Study) but none have been widely translated to populations or conducted in a diverse US population. Telehealth approaches may help overcome barriers to implementing efficacy studies in the US while allowing a scalable solution for translation to large populations (T2) if results are favorable.
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This idea is active.CKD »
Direct renin inhibitors vs. ACEI/ARB for CKD
Theoretical grounds suggest that direct renin inhibitors (Aliskiren) may be superior at slowing CKD progression compared to ACE-inhibitors or ARB, and is supported by some animal studies. Renoprotective effect in humans has been demonstrated, but whether this represents "superiority" remains an unanswered question. Larger trials, including head-to-head comparisons are needed to determine whether direct renin inhibition ...more »
1 comment for Idea: Direct renin inhibitors vs. ACEI/ARB for CKDTheoretical grounds suggest that direct renin inhibitors (Aliskiren) may be superior at slowing CKD progression compared to ACE-inhibitors or ARB, and is supported by some animal studies. Renoprotective effect in humans has been demonstrated, but whether this represents "superiority" remains an unanswered question.
Larger trials, including head-to-head comparisons are needed to determine whether direct renin inhibition provides superior protection against CKD progression, or might replace or supplant ACE/ARB as the standard of care.
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