Conservative management of chronic kidney disease

This volume is dedicated to the conservative management of uremic patients, with a comprehensive presentation of topics including the beneficial effects of proteinuria reduction; the well-established utility of low-protein diet implementation; the detrimental effects associated with hyperphosphatemia; and the fundamentals of the sodium and fluid management in this population. Other innovative themes include the critical function of a balanced intestinal microbiota in reducing uremic toxic burden, and the use of novel intestinal adsorbents that interfere with the absorption of uremic toxins. Last but not least, the key role played by angiotensin-converting-enzyme inhibitors in preserving kidney function via an independent of optimal blood pressure control. Internists and nephrologists have the opportunity to utilize these interventions as tools in their armamentarium in an effort to avoid or defer the initiation of dialysis in advanced chronic kidney disease patients progressing towards end-stage renal disease.
Contents
Sodium and fluid management in the conservative management of chronic kidney disease
Dietary sodium restriction
Dietary sodium restriction and clinical outcomes in CKD
Barriers of sodium restriction in CKD
Water management in CKD
Fluid overload and cardiac remodeling in ESRD
Water intake and kidney disease progression
Conclusions
References
Phosphorus and other aspects of CKD-MBD in the conservative management of chronic kidney disease
Phosphorus distribution
Mineral bone axis
Phosphate handling in the kidney and intestine
Vascular calcification
Bone disease in CKD
Conservative management
Low protein diets
Avoiding added phosphorus
Evaluating the source of dietary phosphorus
Food preparation
Food choices
Pharmacologic interventions
Other aspects of CKD-MBD management
Assessment of phosphorus load and therapeutic targets for CKD-MBD
Conclusions
References
Clinical benefits of phosphate control in progression of end stage renal disease
Phosphate control
Decrease in gastrointestinal adsorption
Efficiency of phosphate removal by hemodialysis
Phosphaturia in dialysis patients with RKF
Phosphaturia in patients undergoing infrequent dialysis
Phosphate balance in infrequent dialysis
Discussion
Conclusions
References
The role of carbon adsorbent in the conservative management of chronic kidney disease
The effects of AST-120, a spherical carbon adsorbent, on uremic toxins
Effects of AST-120 on CKD animals
Effects of AST-120 on CKD patients
Effects of AST-120 on CKD patients with CVD
Safety of AST-120
Conclusions
References
Keto-analogues and essential aminoacids and other supplements in the conservative management of chronic kidney disease
Supplements: aminoacids and ketoacids
Supplements: energy
Supplements: miscellaneous
Conclusions
References
The role of low protein diet in ameliorating proteinuria and deferring dialysis initiation: what is old and what is new
Low-protein diet regimens in CKD patients
Effect of dietary protein restriction on proteinuria
Dietary protein restriction and delay of dialysis initiation
Adaptive changes to dietary protein restriction
Strategies to start a low-protein diet
Conclusions
References
Use of ACE inhibition and blood pressure management in deferring dialysis initiation
Blood pressure reduction for nephroprotection
The renin angiotensin system blockers: when and whether to use them
The dual blockade of RAS blockers: a missed opportunity or a dangerous path?
The risks of RAS blockers
References
Microbiota and prebiotics modulation of uremic toxin generation
Intestinal microbiota and chronic kidney disease
Uremic toxins production and intestinal microbiota
Biologic impact of URS of intestinal microbiota origin
Prebiotics as an attractive therapeutic option
Prebiotic and CKD
Conclusions
References
Incremental and infrequent hemodialysis: a new paradigm for both dialysis initiation and conservative management
History of triweekly hemodialysis
Adequacy targets: clinical practice guidelines
Residual kidney function and rationale for the incremental dialysis regimen
Incremental hemodialysis and outcomes
Practical implementation of incremental dialysis
Conclusions
References