Univ.-Prof. Dr. Jens Lutz (Germany): Possibilities of slowingdown progression and management of chronic kidney diseases

Chronic kidney diseases (CKD) are an increasing worldwide problem, which is also reflected by the fact that CKD is an increasing reason for overall mortality. Blood pressure control is a key factor to delay the progression of CKD. However, little evidence exists for the correct target levels in patients with CKD. A central mechanism to control the blood pressure in CKD patients is the blockade of the renin angiotensin aldosterone system (RAAS) by angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB). Due to their additional effects regarding the reduction of proliferation and inflammation, independent of their blood pressure lowering effects, these compounds are well suitable for delaying the progression of CKD. Furthermore, a dyslipidemia should be treated in patients with CKD, although such effects in reducing cardiovascular risks are lower in CKD patients as compared to the general population. The treatment should be started with statins. Blood glucose should be managed in order to aquire HbA1c levels below 7%. Life style factors, among them particularly the diet, are of special importance for the progression of CKD. Here, especially the sodium intake, the production of uric acid as well as the control of the acid base metabolism should be considered. Altogether the progression of CKD can be delayed by controlling these factors, while it is necessary to better define target values as well as to analyze new therapeutics particularly in patients with CKD.

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