Chronic Kidney Disease (CKD) is a worldwide health problem.
The disease is most often progressive of nature with a high impact on patients and society. It is increasingly recognized that CKD can be detected in early stages and should be managed as early as possible. Treatment of the cause, but in particular control of the main risk markers, such as high blood pressure, glucose, and albuminuria, has been instrumental in delaying the progression to end-stage renal disease (ESRD). However, despite the state-of-the-art therapy, the absolute risk of renal and cardiovascular morbidity and mortality in CKD patients remains devastatingly high. Novel drugs are therefore highly desirable to effectively halt the progressive renal (and cardiovascular) function loss. Recently, several novel strategies have been tested targeting traditional risk factors such as blood pressure (combination therapy of ACEi and ARB and novel mineralocorticoid receptor antagonists) as well as dyslipidemia (statins) with surprising results. In addition, drug targets specifically related to the kidney, such as vitamin D, uric acid, erythropoietin, and phosphate have been subject of clinical trials; in some instances with unexpected results. Finally, novel targets including endothelin receptors and inflammatory pathways are increasingly explored as potential avenues to improve renal and cardiovascular protection, albeit that the drugs tested have not been unequivocally successful. In this article we review novel drugs or intervention strategies for the management of CKD, we try to provide explanations for the failure of some promising drugs, and hypothesize on the potential success of new strategies.
Written by:
Heerspink HL, de Zeeuw D. Are you the author?
Department of Clinical Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Reference: Br J Clin Pharmacol. 2013 Jun 26. Epub ahead of print.
doi: 10.1111/bcp.12195
PubMed Abstract
PMID: 23802504
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