Pathogenesis and Prevention of Progression of Chronic Kidney Disease

Anil K. Mandal^1,2,3

¹Putnam Community Medical Center, Palatka, USA.
²University of Florida, Gainesville, USA.
³University of North Carolina at Chapel Hill, Chapel Hill, USA.

DOI: 10.4236/ojim.2015.53010                

Abstract

This treatise of chronic kidney disease (CKD) describes association of hypertension, diabetes and congestive heart failure (CHF) with CKD. CKD is defined by estimated glomerular filtration rate (eGFR) of less than 60 ml/min for three months or more. CKD is generally irreversible but not necessarily progressive. Thus progression of CKD into end stage renal disease (ESRD) is the concern here and what can be done to reduce the progression of CKD. Exact data of CKD with progression are unavailable but high incidence of ESRD (dialysis) eleven times more in 2011 than in 1980 accordingly to United States (US) Renal Data System is a testimonial to progression of CKD in patients with diabetes, hypertension, CHF and other renal diseases. US Renal Data System reveals that ESRD has soared in parallel with marketing of angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) drugs, providing strong indirect evidence that these drugs are someway instrumental in the progression of CKD into ESRD. These drugs produce acute renal failure which is an independent risk factor for CKD. Thus shift in therapy with enthusiastic use of ACEI/ARB drugs has led to dialysis bonanza throughout the world benefiting the professionals and corporations at the expense of vegetative life of the patients associated with family and societal burdens. The ways to turn the pendulum is to treat diabetes with insulin and hypertension with beta blocker, calcium channel blocker and diuretic therapy, and avoid the use of ACEI/ARB drugs. It is important to understand that diuretic orally, by intravenous boluses or by continuous infusion, is the cornerstone of therapy for CHF, whereas ACEI/ARB drugs markedly impair the efficacy of diuretics by lowering the blood pressure to a very low level thereby reducing renal perfusion. An evidence for that is marked elevation of BUN with comparatively slight increase of serum creatinine. Thus with the approaches stated above, CKD is less likely to progress; hence rate of ESRD is likely to decrease.

Keywords

Pathogenesis, Prevention, Chronic Kidney Disease

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Chobanian, A.V., Bakris, G.L., Black, H.R., Cushman, W.C., Green, L.A., Izzo Jr., J.L., et al., the National Heart, Lung, and Blood Pressure Coordinating Committee (2003) Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood pressure. Hypertension, 42, 1206-1252. http://dx.doi.org/10.1161/01.HYP.0000107251.49515.c2
[2]	National Kidney Foundation (2002) K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification and Satisfaction. American Journal of Kidney Diseases, 39, S1-S266.
[3]	Woodhouse, S., Batten Hendrick, H. and Malek, P.A. (2006) The Glomerular Filtration Rate: An Important Test for Diagnosis, Staging, and Treatment of Chronic Kidney Disease. Lab Medicine, 37, 244-246.
[4]	Couser, W.G., Remuzzi, G., Medis, S. and Tonelli, M. (2011) The Contribution of Chronic Kidney Disease to the Global Burden of Non-Communicable Diseases. Kidney International, 80, 1258-1270. http://dx.doi.org/10.1038/ki.2011.368
[5]	Muntner, P., Anderson, A., Charleston, J., Chen, Z., Ford, V., Makos, G., O’Connor, A., Perumal, K., Rahman, M., Steigerwarlt, S., Teal, V., Townsend, R., Weir, M. and Wright, J.T. (2010) Hypertension Awareness, Treatment and Control in Adults with CKD Results from the Chronic Renal Insufficiency Cohort (CRIC) Study. American Journal of Kidney Diseases, 55, 441-451. http://dx.doi.org/10.1053/j.ajkd.2009.09.014
[6]	Loniewski, I. and Wesson, D.E. (2014) Bicarbonate Therapy for Prevention of Chronic Kidney Disease Progression. Kidney International, 85, 529-535. http://dx.doi.org/10.1038/ki.2013.401
[7]	Rajapurkar, M.M., John, G.T., Kirpalani, A.L., Abraham, G., Agarwal, S.K., Almeida, A.F., Gang, S., Gupta, A., Modi, G., Pahari, D., Pisharody, R., Prakash, J., Raman, A., Rana, D.S., Sharma, R.K., Sahoo, R.N., Sakhuja, V., Tatapudi, R.R. and Jha, V. (2012) What Do We Know about Chronic Kidney Disease in India: First Report of the Indian CKD Registry. BMC Nephrology, 13, 10. (Open Access) http://dx.doi.org/10.1186/1471-2369-13-10
[8]	Singh, A.K., Farag, Y.M.K., Mittal, B.V., Subramanian, K.K., Reddy, S.R.K., Acharya, V.N., Almeida, A.F., Channakeshavamurthy, A., Ballal, H.S.P.G., Issacs, R., Jasuja, S., Kirpalani, A.L., Kher, V., Modi, G.L., Mainan, G., Prakash, J., Rana, D.S., Sreedhara, R., Sinha, D.K.V.S.B., Sunder, S., Sharma, R.K., Seetharam, S., Raju, T.R. and Rajapurkar, M. (2013) Epidemiology and Risk Factors of Chronic Kidney Disease in India—Results from Seed (Screening and Early Evaluation of Kidney Disease) Study. BMC Nephrology, 14, 114. (Open Access)
[9]	Harris, M.I. (1993) Undiagnosed NIDDM: Clinical and Public Health Issues. Diabetes Care, 16, 642-652. http://dx.doi.org/10.2337/diacare.16.4.642
[10]	The DECODE Study Group and on Behalf of the European Diabetes Epidemiology Group (2003) Is the Current Definition of Diabetes Relevant to Mortality Risk from All Causes and Cardiovascular and Non-Cardiovascular Disease? Diabetes Care, 26, 688-696. http://dx.doi.org/10.2337/diacare.26.3.688
[11]	Lewis, E.J., Hunsicker, L.G., Bain, R.P. and Rohde, R.D. (1993) The Effect of Anigiotensin Converting Enzyme Inhibitions on Diabetic Nephropathy. New England Journal of Medicine, 329, 1456-1462. http://dx.doi.org/10.1056/NEJM199311113292004
[12]	Mandal, A.K., Hiebert, L.M. and Khamis, H. (2011) dGlucose Is Linked to Renal Function Changes in Diabetes. Diabetes Research and Clinical Practice, 91, 190-194. http://dx.doi.org/10.1016/j.diabres.2010.11.013
[13]	Mandal, A.K. and Hiebert, L.M. (2012) Control of Postprandial Hyperglycemia: How Important Is It in the Prevention of Diabetic Complication. Current Trends in Endocrinology, 6, 53-63.
[14]	Patel, V.D., Hernandez, A.F., Liang, L., Peterson, E.D., LaBresh, K.A., Yancy, C.W., Albert, N.M., Ellrodt, G. and Fonarow, G.C. (2008) Quality of Care and Outcomes among Patients with Heart Failure and Chronic Kidney Disease: A Get with the Guidelines—Heart Failure Program Study. American Heart Journal, 156, 674-681. http://dx.doi.org/10.1016/j.ahj.2008.05.028
[15]	Packer, M., Lee, W.H., Medina, N., Yushak, M. and Kessler, P.D. (1987) Functional Renal Insufficiency during Long-Term Therapy with Captopril and Enalapril in Severe Chronic Heart Failure. Annals of Internal Medicine, 106, 346-354. http://dx.doi.org/10.7326/0003-4819-106-3-346
[16]	Mandal, A.K. (2014) Pathophysiology, Prevention and Treatment of Severe Congestive Heart Failure Associated with Progressive Renal Failure. Journal of Cardiology and Therapy, 1, 41-45.
[17]	Mandal, A.K. (2014) Frequent Office Visit of Patients with Chronic Kidney Disease: Is a Prelude to Prevention of Dialysis. World Journal of Nephrology, 3, 1-5.
[18]	Brown, E.A. (2012) What Can We Do to Improve Quality of Life for the Elderly Chronic Kidney Disease Patient. Aging Health, 8, 519-524. http://dx.doi.org/10.2217/ahe.12.49
[19]	Lea, J., Green, T., Hebert, L., Lipkowitz, M., Massry, S., Middleton, J., Rostand, S.G., Miller, E., Smith, W. and Bakris, G.L. (2005) The Relationship between Magnitude of Proteinuria Reduction and Risk of End-Stage Renal Disease: Results of the African American Study of Kidney Disease and Hypertension. Archives of Internal Medicine, 165, 947-953. http://dx.doi.org/10.1001/archinte.165.8.947
[20]	Remuzzi, G., Chiurchiu, C. and Ruggenenti, P. (2004) Proteinuria Predicting Outcome in Renal Disease: Nondiabetic Nephropathies (REIN). Kidney International, 92, S90-S96. http://dx.doi.org/10.1111/j.1523-1755.2004.09221.x
[21]	Hovind, P., Rossing, P., Tarnow, L., Toft, H., Parving, J. and Parving, H.H. (2001) Remission of Nephrotic Range Albuminuria in Type 1 Diabetic Patients. Diabetes Care, 24, 1972-1977. http://dx.doi.org/10.2337/diacare.24.11.1972
[22]	Lewis, J. (2007) Treating Diabetic Nephropathy: Unfinished Success Is Not Failure. Clinical Journal of the American Society of Nephrology, 2, 407-409. http://dx.doi.org/10.2215/CJN.01170307
[23]	Ficociello, L.H., Perkins, B.A., Silva, K.H., Finkelstein, D.M., Ignatowska-Switalska, H., Gaciong, Z., Cupples, L.A., Aschengrau, A., Warram, J.H. and Kroleski, A.S. (2007) Determinants of Progression from Microalbuminuria to Proteinuria in Patients Who Have Type 1 Diabetes and Are Treated with Angiotensin-Converting Enzyme Inhibitors. Clinical Journal of the American Society of Nephrology, 2, 461-469. http://dx.doi.org/10.2215/CJN.03691106
[24]	Warram, J.H., Scott, L.J., Hanna, L.S., Wantman, M., Cohen, S.E., Laffel, L.M., Ryan, L. and Krolewski, A.S. (2000) Progression of Microalbuminuria to Proteinuria in Type 1 Diabetes: Nonlinear Relationship with Hyperglycemia. Diabetes, 49, 94-100. http://dx.doi.org/10.2337/diabetes.49.1.94
[25]	Himmelfarb, J., Berns, A., Szczech, L. and Wesson, D. (2007) Cost, Quality, and Value: The Changing Political Economy of Dialysis Care. Journal of the American Society of Nephrology, 18, 2021-2027. http://dx.doi.org/10.1681/ASN.2007020152
[26]	de Brito-Ashurst, I., Varagunan, M., Raftery, M.J. and Yaqoob, M. (2009) Bicarbonate Supplementation Slows Progression of CKD and Improves Nutritional Status. Journal of the American Society of Nephrology, 20, 2075-2084. http://dx.doi.org/10.1681/ASN.2008111205
[27]	Berger, J.R. and Hedayati, S.S. (2012) Renal Replacement Therapy in Elderly Population. Clinical Journal of the American Society of Nephrology, 7, 1039-1046. http://dx.doi.org/10.2215/CJN.10411011
[28]	Mandal, A.K. (2013) Renal Failure Is Not a Prodrome of Dialysis. International Journal of Medical Sciences and Biotechnology, 1, 1-14.