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:6/26/2016)... (PRWEB) , ... June 26, 2016 , ... PawPaws ... a new product that was developed to enhance the health of felines. The formula ... , The two main herbs in the PawPaws Cat Kidney Support Supplement ...
(Date:6/25/2016)... ... ... Austin residents seeking Mohs surgery services, can now turn to Dr. Jessica Scruggs ... for medical and surgical dermatology. , Dr. Dorsey brings specialization to include Mohs surgery, ... Micrographic Surgery completed by Dr. Dorsey was under the direction of Glenn Goldstein, MD, ...
(Date:6/25/2016)... ... ... As a lifelong Southern Californian, Dr. Omkar Marathe earned his Bachelors in ... School of Medicine at UCLA. He trained in Internal Medicine at Scripps Green Hospital ... at the UCLA-Olive View-Cedars Sinai program where he had the opportunity to train in ...
(Date:6/24/2016)... (PRWEB) , ... June 24, 2016 , ... A recent ... that most people are unfamiliar with. The article goes on to state that individuals ... also many of these less common operations such as calf and cheek reduction. The ...
(Date:6/24/2016)... ... 2016 , ... The Pulmonary Hypertension Association (PHA) learned during ... two significant new grants to support its work to advance research and patient ... recognizing patients, medical professionals and scientists for their work in fighting pulmonary hypertension ...
Breaking Medicine News(10 mins):
(Date:6/24/2016)...  Collagen Matrix, Inc., ("Collagen Matrix") the driving ... collagen and mineral based medical devices for tissue ... Messer has joined the company as Vice ... growing portfolio of oral surgery, neurosurgery, orthopaedic and ... the Collagen Matrix executive team as an accomplished ...
(Date:6/24/2016)... June 24, 2016   Bay Area Lyme ... Dean Center for Tick Borne Illness , ... Rehabilitation, MIT Hacking Medicine, University of California, Berkeley, ... announced the five finalists of Lyme Innovation ... More than 100 scientists, clinicians, researchers, entrepreneurs, and ...
(Date:6/24/2016)... -- Research and Markets has announced ... Applications, Technologies, Forecasts" report to their offering. ... Smart Skin, Structural Health Monitoring, Composite Smart Structures, ... involves electronic and/or electrical components and circuits that ... such as vehicle bodies or conformally placed upon ...
Breaking Medicine Technology: