CKD Management: A Look into the Future

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AM El Nahas
M El Kossi

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Abstract

CKD: The Global Challenge Globally, an increasing number of patients with end-stage renal disease (ESRD) are treated by dialysis or transplantation. It is estimated that by 2010 over 2 million individual will be on renal replacement therapy (RRT) worldwide [I]. This global increase in ESRD reflects, to some extent, the ageing of the population in the West and the steady increase in the number of those suffering from diabetes mellitus and diabetic nephropathy. The majority of those having access to RRT live in the West where such facility and resource are available and affordable; those living in the developing countries often die from ESRD with little opportunities for dialysis or transplantation. Of concern is the fact that ESRD patients represent a small percentage (0.1%) of the population, whilst there may be as many as 10% of the population suffering from chronic kidney disease (CKD), those either will eventually reach ESRD or are more likely to die from cardiovascular complications before reaching that a stage of renal insufficiency. The huge population burden of CKD needs urgent attention as it is likely to increase over the next decade in view of the global rise in chronic, non-communicable, diseases such as diabetes, obesity, hypertension all known to impact on CKD. Furthermore, CKD itself has a negative impact on these conditions increasing both their morbidity and mortality. So far, the management of CKD has been confined to the treatment of its complications namely hypertension and proteinuria with little attempt made to reverse the underlying chronic scarring process. Chronic kidney disease is associated with progressive kidney remodelling and scarring regardless of the initial cause of injury

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