Role of screening, monitoring in early kidney disease unclear

April 17, 2012 By Serena Gordon, HealthDay Reporter
Role of screening, monitoring in early kidney disease unclear
Certain blood pressure-lowering drugs most effective treatment, reports review.

(HealthDay) -- 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 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 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 , 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 .

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 , such as heart disease, 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 and need dialysis, but having early chronic kidney disease increases a person's risk of heart disease, stroke, 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 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.

Explore further: Similar blood pressure drugs could have different impacts on dialysis patients' heart health

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

Related Stories

Similar blood pressure drugs could have different impacts on dialysis patients' heart health

December 8, 2011
Two seemingly similar blood pressure–lowering drugs have different effects on the heart health of dialysis patients, according to a study appearing in an upcoming issue of the Journal of the American Society Nephrology ...

Reducing risk of renal failure in obese patients

April 28, 2011
The angiotensin-converting enzyme (ACE) inhibitor drug, ramipril, is particularly effective in lowering the risk of end-stage renal disease (ESRD) in obese patients, according to a study appearing in an upcoming issue of ...

Poor growth, delayed puberty and heart problems plague kids with mild kidney disease

August 12, 2011
Children with only mildly to moderately impaired kidney function experience poor growth, delays in puberty, and heart problems, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society ...

Recommended for you

Creation of synthetic horsepox virus could lead to more effective smallpox vaccine

January 19, 2018
UAlberta researchers created a new synthetic virus that could lead to the development of a more effective vaccine against smallpox. The discovery demonstrates how techniques based on the use of synthetic DNA can be used to ...

Study ends debate over role of steroids in treating septic shock

January 19, 2018
The results from the largest ever study of septic shock could improve treatment for critically ill patients and save health systems worldwide hundreds of millions of dollars each year.

New approach could help curtail hospitalizations due to influenza infection

January 18, 2018
More than 700,000 Americans were hospitalized due to illnesses associated with the seasonal flu during the 2014-15 flu season, according to federal estimates. A radical new approach to vaccine development at UCLA may help ...

Zika virus damages placenta, which may explain malformed babies

January 18, 2018
Though the Zika virus is widely known for a recent outbreak that caused children to be born with microencephaly, or having a small head, and other malformations, scientists have struggled to explain how the virus affects ...

Certain flu virus mutations may compensate for fitness costs of other mutations

January 18, 2018
Seasonal flu viruses continually undergo mutations that help them evade the human immune system, but some of these mutations can reduce a virus's potency. According to new research published in PLOS Pathogens, certain mutations ...

Study reveals how MRSA infection compromises lymphatic function

January 17, 2018
Infections of the skin or other soft tissues with the hard-to-treat MRSA (methicillin-resistant Staphylococcus aureus) bacteria appear to permanently compromise the lymphatic system, which is crucial to immune system function. ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.