5 mEq/L. Serum creatinine level may be excessively elevated due to: (1) renal artery stenosis, (2) administration of NSAIDs, (3) heart failure, (4) dehydration or (5) urinary tract abnormality. If these are possible, ACE inhibitors or ARBs is carefully continued or should be discontinued. https://www.selleckchem.com/products/a-1210477.html Physicians are always aware that elderly patients can easily fall into dehydration in summertime and that NSAIDs are frequently prescribed by other medical providers, which may injure kidney. Combination therapy to achieve target blood pressure In clinical studies, 3–5 antihypertensive agents are usually used in combination for strict blood pressure control. Other agents are combined when monotherapy by ACE inhibitors or ARBs fails

to achieve the target blood pressure. Diuretics A combination of a diuretic in a small dose can enhance antihypertensive Selleck MCC950 effects of other agents. Calcium-channel blocking agents (CCBs) CCBs, if combined with other agents, strictly lower blood pressure and suppress CKD progression more easily. Other antihypertensive agents There is no clinical evidence of α-blockers, β-blockers or central sympatholytic agents being effective directly in CKD. These agents however are expected to suppress CKD progression through lowering blood pressure. Prevention of decline in GFR through reduction of urinary protein excretion Urinary protein is a critical risk factor

for progression of CKD. It is considered that prognosis of CKD can be prevented by reduction of urinary protein. ACE inhibitors and ARBs are superior to other antihypertensive

agents in reducing urinary protein. Beneficial effects of these drugs on CKD progression depend mainly on their decreasing effects on urinary protein. If sufficient reduction Inositol monophosphatase 1 of urinary protein is not attained, it is recommended that ACE inhibitors or ARBs be increased in dose to maximum while attention is being paid to blood pressure and adverse effects. ACE inhibitors or ARBs are demonstrated to reduce CVD events through alleviating microalbuminuria or proteinuria. The target of urinary protein reduction is less than 0.5 g/g creatinine.”
“The goal of CKD management is to suppress both the progression to end-stage kidney disease (ESKD) and the occurrence of cardiovascular disease (CVD). A multi-modal therapeutic approach is essential for the suppression of ESKD and CVD development. The purpose of CKD management The primary aim of CKD management is to prevent CKD or retard its progression to ESKD, which severely impairs the quality of life of CKD patients. The second aim is to suppress newly onset CVD or the progression of preexisting CVD through management of CKD, which itself is a risk factor for CVD development. The management of ESKD requires relatively costly renal replacement therapies, such as hemodialysis, peritoneal dialysis, or kidney transplantation. Therefore, the management of CKD is critical for maintaining an economically viable public C188-9 datasheet healthcare system.