| Theme | Medical treatment, nursing care, and life support for patients with advanced CKD stages | |
|---|---|---|
| Title | Pharmacotherapies for chronic kidney disease (CKD) : managements of haypertension, dyslipidemia, and anemia | |
| Publish Date | 2013/06 | |
| Author | Kumiko Moriwaki | Department of Cardiorenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University |
| Author | Hideyasu Kiyomoto | Department of Community Medical Supports, Tohoku Medical Megabank Organization |
| [ Summary ] | Chronic kidney disease (CKD) is associated with an increased incidence of cardiovascular disease. Hypertension, dyslipidemia and anemia respectively are risk factors for progression of CKD and cardiovascular disease. Ideal blood pressure（BP）levels should be 130/80 mmHg for patients with CKD. Angiotensin II type 1 receptor blockers (ARB) and angiotensin-converting-enzyme (ACE) inhibitors are the first choice of antihypertensive drugs for CKD patients with proteinuria or diabetes. The major adverse effects of ARB are hyperkalemia and temporal decreases in glomerular filtration rates (GFR). Japan atherosclerosis society guidelines for prevention of atherosclerotic cardiovascular disease recommend LDL-C treatment goals of < 100 mg/dL, HDL-C > 40 mg/dL, triglycerides levels of <150 mg/dL for CKD patients. Statins may reduce proteinuria as observed in large clinical studies. For patients with GFR lower than 60 mL/min per 1.73 m2, statins and/or fibrates may increase the incidence of rhabdomyolysis in some cases. Anemia is a major complication of CKD. Treating anemia by administering erythropoiesis stimulating agents (ESA) and/or suitable iron supplementation should be implemented when hemoglobin (Hb) levels are <10 g/dL. Hb levels should be 11-13 g/dL. Targeting Hb levels in excess of 13 g/dL may increase the rate of adverse events. |
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