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Nephrol Dial Transplant (2000) 15: 1529-1534
© 2000 European Renal Association-European Dialysis and Transplant Association

Special Feature

The management of chronic renal insufficiency in the conservative phase

Francesco Locatelli1,, Fernando Valderrábano2, Nicholas Hoenich3, Jurgen Bommer4, Karel Leunissen5 and Vincenzo Cambi6

1 Azienda Ospedale di Lecco, Lecco, Italy, 2 University Hospital Gregorio Marañon, Madrid, Spain, 3 Department of Nephrology, School of Clinical Medical Sciences, University of Newcastle, UK, 4 University Hospital, Heidelberg, Germany, 5 University Hospital, Maastricht, The Netherlands, and 6 Department of Clinical Medicine, Nephrology and Preventive Medicine, University of Parma, Italy

Introduction

Locatelli: There has been a striking increase in the incidence of end-stage renal disease (ESRD) over the last 30 years world-wide [1]. The growing proportion of elderly patients mainly accounts for the total increase in the number of these patients admitted to renal replacement therapy (RRT), with a dramatically high morbidity and mortality rate [1–3].

A number of physiological and metabolic changes may contribute not only towards progressive loss of renal function but also to increased mortality observed thereafter, during the dialytic phase. The detection and correction of these events may slow the progression of chronic renal insufficiency (CRI) and delay the need for dialysis. Thus the question of whether therapeutic interventions may retard the progression of CRI in man is extremely important not only clinically, but also in terms of patient suffering and the social and economic impact of regular RRT [. . . [Full Text of this Article]

Pre-dialysis—overall objectives

Protein and calorie intake

Acid-base balance

Blood pressure control

Anaemia correction

Calcium—phosphorus metabolism

When to start dialysis

Consensus on pre-dialysis treatments

Acknowledgments

Notes

References


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