Unraveling the complexities of chronic kidney disease

In New England Journal of Medicine, President Henrich and Professor Abboud examine a condition that affects 26 million American adults

SAN ANTONIO (Jan. 7, 2010) — Late-stage chronic kidney disease is complex and often coexists with other serious conditions. To manage it, physicians should consider a multifaceted approach that slows progression of the disease while addressing related conditions and potentially preparing the patient for dialysis or a kidney transplant.
In the current issue of The New England Journal of Medicine, President William L. Henrich, M.D., M.A.C.P., and Professor Hanna Abboud, M.D., of The University of Texas Health Science Center at San Antonio examine the intricacies of stage IV chronic kidney disease and offer treatment recommendations.
Drs. Henrich and Abboud co-authored the “Clinical Practice” feature in the Jan. 7 issue of the journal. This feature highlights common clinical problems, presents evidence supporting various strategies, reviews any formal guidelines and makes clinical recommendations.
According to the National Kidney Foundation, 26 million U.S. adults have chronic kidney disease, with Hispanics and African-Americans at increased risk. Major causes of severe chronic kidney disease include diabetes and high blood pressure, which together account for more than 70 percent of cases.
Chronic kidney disease is characterized by a progressive decline in the kidneys’ ability to filter and remove waste products from blood. It has five stages; Stage V indicates kidney failure with a need for dialysis.
In their journal article, Drs. Henrich and Abboud – both of whom are on the faculty of the Division of Nephrology in the UT Health Science Center’s School of Medicine – considered the case of a 54-year-old female patient with significantly reduced kidney function and an 11-year history of type 2 diabetes.
In cases like these, physicians must correctly diagnose the primary renal disease while paying attention to coexisting conditions and understanding systemic complications. Reversible conditions that acutely worsen chronic kidney disease should be identified and treated.
In addition to having a high rate of coexisting conditions, chronic kidney disease patients often need a large number of medicines. Meticulous follow-up is required at each doctor’s visit.
Chronic kidney disease is a well-known risk factor for cardiovascular disease. Very few patients with chronic kidney disease secondary to diabetes ultimately need dialysis or kidney transplants, in part because many die of cardiovascular causes before reaching end-stage renal disease.
As a result, it is important to address cardiovascular risk factors in patients with chronic kidney disease. Recommendations include quitting smoking, exercising, and managing diet, weight, blood pressure and blood sugar, among other strategies.
Controlling high blood pressure has been shown to slow progression of chronic kidney disease. Other positive steps can include controlling blood sugar levels, treating disorders of mineral and bone metabolism and reducing proteinuria, where abnormally high amounts of protein leave the body in urine.
Studies indicate that many patients with stage IV chronic kidney disease are not seen by a nephrologist. Such delayed referrals are associated with less-than-optimal outcomes, including increased risk of mortality.
The full text of the article can be found at http://content.nejm.org/cgi/content/full/362/1/56.




The University of Texas Health Science Center at San Antonio is the leading research institution in South Texas and one of the major health sciences universities in the world. With an operating budget of $668 million, the Health Science Center is the chief catalyst for the $16.3 billion biosciences and health care sector in San Antonio’s economy. The Health Science Center has had an estimated $36 billion impact on the region since inception and has expanded to six campuses in San Antonio, Laredo, Harlingen and Edinburg. More than 25,600 graduates (physicians, dentists, nurses, scientists and other health professionals) serve in their fields, including many in Texas. Health Science Center faculty are international leaders in cancer, cardiovascular disease, diabetes, aging, stroke prevention, kidney disease, orthopaedics, research imaging, transplant surgery, psychiatry and clinical neurosciences, pain management, genetics, nursing, dentistry and many other fields. For more information, visit www.uthscsa.edu.

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