Navigation Links
Role of Screening, Monitoring in Early Kidney Disease Unclear
Date:4/17/2012

By Serena Gordon
HealthDay Reporter

TUESDAY, April 17 (HealthDay News) -- At least one in 10 U.S. adults is estimated to have chronic kidney disease, but whether screening and monitoring people in the earlier stages of the disease provides a benefit just isn't clear, a new review of the available clinical trials revealed.

The finding doesn't necessarily mean that early screening or monitoring of kidney disease isn't helpful, it just shows no clear evidence to prove that it is. "We didn't find direct evidence for benefits or harms. There were no randomized controlled trials for screening or monitoring," said the study's lead author, Dr. Howard Fink, a staff physician at the Veterans Affairs Medical Center in Minneapolis, Minn.

But, when the reviewers looked at the treatment options available to people with early-stage chronic kidney disease, they found evidence that two types of blood pressure-lowering medication reduced progression to end-stage kidney disease and one medication reduced the risk of death.

The two medication classes were angiotensin-converting enzyme (ACE) inhibitors and angiotensin II-receptor blockers (ARBs). The benefits from these medications were stronger in people who had worsening kidney disease and those with diabetes, according to the review.

Results of the review are published in the April 17 issue of the Annals of Internal Medicine.

Eleven percent of American adults have chronic kidney disease in its earliest stages (one through three), according to the review. Chronic kidney disease is more likely to occur in older people, and those with other chronic medical conditions, such as heart disease, high blood pressure and diabetes. Most people don't have symptoms of early chronic kidney disease. It is detected through urine and blood tests.

Not everyone with chronic kidney disease will develop end-stage renal disease and need dialysis, but having early chronic kidney disease increases a person's risk of heart disease, stroke, kidney failure and death, according to the review.

The researchers searched available medical literature from 1985 through November 2011 for randomized, controlled clinical trials of people with early chronic kidney disease. A randomized controlled trial, considered the "gold standard" in research, is a study in which people are randomly assigned to receive one of several interventions.

The investigators found no trials that evaluated screening or monitoring for those with early disease, so they were unable to determine whether early detection and follow-up care would be beneficial or not.

When they searched for early chronic kidney disease treatment trials, they found 110 randomized controlled studies that included a number of treatments.

The review found that ACE inhibitors decreased the risk of end-stage renal disease by 35 percent and ARBs reduced the risk by 23 percent compared to an inactive placebo. The risk reduction was most significant for people who had signs of worsening kidney disease (macroalbuminuria).

The researchers also found evidence that ACE inhibitors lowered the risk of death by 21 percent compared to placebo in people who had more serious kidney disease, cardiovascular disease and poorly controlled diabetes.

"The risk of people with mild chronic kidney disease developing end-stage renal disease is very low, so it may be that these medications have a unique benefit in people with worse chronic kidney disease, or it may be that you just don't have enough statistical power in these trials to see the benefits in people with milder chronic kidney disease," explained Fink.

ACE inhibitors include: captopril (Capoten), enalapril (Vasotec), ramipril (Altace) and quinapril (Accupril). ARBs include: candesartan (Atacand), valsartan (Diovan), losartan (Cozaar) and olmesartan (Benicar).

Other blood pressure-lowering medications didn't provide the same benefits as ACE inhibitors and ARBs. Statins (cholesterol-lowering drugs) and beta blockers (drugs that help regulate heart rate and lower blood pressure) showed a reduction in the risk of death and cardiovascular events compared to placebo, but only in people with worsening kidney disease, or high cholesterol or congestive heart failure.

"This review shows that the evidence in early chronic kidney disease is very, very weak. The problem right now is that no one knows who will get worse and progress to end-stage renal disease," said Dr. Robert Provenzano, chair of the department of nephrology at St. John Providence Health System in Detroit, Mich.

Provenzano added that he wasn't surprised the reviewers found ACE inhibitors and ARBs to be most effective for people with early kidney disease.

He said that if people are interested in keeping their kidneys healthy, they should follow the same advice for keeping your heart healthy. Eat right to control your blood sugar, cholesterol and blood pressure levels. Limit the salt in your diet. Don't smoke, and stay active.

More information

Learn more about chronic kidney disease from the National Kidney Foundation.

SOURCES: Howard Fink, M.D., M.P.H., staff physician, Veterans Affairs Medical Center, Minneapolis, Minn.; Robert Provenzano, M.D., chair, department of nephrology, St. John Providence Health System, Detroit, Mich.; April 17, 2012, Annals of Internal Medicine


'/>"/>
Copyright©2010 ScoutNews,LLC.
All rights reserved  

Related medicine news :

1. Pap Test Still Best for Cervical Cancer Screening, Experts Say
2. Health providers should emphasize breast cancer screening, Wayne State University research finds
3. Monitoring antibiotic use cuts millions in wasteful spending, study finds
4. Home monitoring may help manage and reduce costs for heart failure
5. Monitoring food with millimeter waves
6. Blood pressure monitoring: Room for improvement
7. Panel endorses active monitoring and delay of treatment for low-risk prostate cancer
8. Self-Monitoring of Blood Thinner May Halve Clot Risk
9. Warfarin May Need Less Monitoring for Some
10. After Brain Injury, Oxygen Monitoring Vital, Study Finds
11. MRIs could become powerful tools for monitoring cholesteral therapy
Post Your Comments:
*Name:
*Comment:
*Email:
Related Image:
Role of Screening, Monitoring in Early Kidney Disease Unclear
(Date:6/25/2016)... Montreal, Canada (PRWEB) , ... June 25, 2016 , ... ... the pursuit of success. In terms of the latter, setting the bar too high ... low, risk more than just slow progress toward their goal. , Research from ...
(Date:6/24/2016)... ... 2016 , ... June 19, 2016 is World Sickle Cell Observance Day. In ... benefits of holistic treatments, Serenity Recovery Center of Marne, Michigan, has issued ... Sickle Cell Disease (SCD) is a disorder of the red blood cells, which can ...
(Date:6/24/2016)... MIAMI, Fla. (PRWEB) , ... June 24, 2016 , ... ... Florida Trend magazine’s 2016 Legal Elite. The attorneys chosen by their peers for this ... of Florida. , Seven Greenberg Traurig Shareholders received special honors as members of this ...
(Date:6/24/2016)... ... ... Inc, makers of Topricin and MyPainAway Pain Relief Products, join The ‘Business for a Fair ... hour by 2020 and then adjusting it yearly to increase at the same rate as ... the wage floor does not erode again, and make future increases more predictable. , The ...
(Date:6/24/2016)... NY (PRWEB) , ... June 24, 2016 , ... ... Haute Living, is proud to recognize Dr. Barry M. Weintraub as a prominent ... “the most beautiful women in the world, and the most handsome men, look ...
Breaking Medicine News(10 mins):
(Date:6/24/2016)... --  Pulmatrix, Inc ., (NASDAQ: PULM ), ... today that it was added to the Russell Microcap ... set of U.S. and global equity indexes on June ... for Pulmatrix," said Chief Executive Officer Robert Clarke ... in developing drugs for crucial unmet medical needs, and ...
(Date:6/23/2016)... June 23, 2016  MedSource announced today that ... e-clinical software solution of choice.  This latest decision ... value to their clients by offering a state-of-the-art ... relationship establishes nowEDC as the EDC platform of ... full-service clients.  "nowEDC has long been a preferred ...
(Date:6/23/2016)... , June 23, 2016 Research ... "Pharmaceutical Excipients Market by Type (Organic Chemical (Sugar, Petrochemical, ... (Oral, Topical, Coating, Parenteral) - Global Forecast to 2021" ... The global pharmaceutical excipients market is ... a CAGR of 6.1% in the forecast period 2016 ...
Breaking Medicine Technology: