Despite a widespread preconception that HD should be reserved for cases in which PD is not feasible, in Europe, we found 1 in 8 infants in need of maintenance dialysis to be initiated on HD therapy. Patient characteristics at dialysis therapy initiation, prospective survival, and time to transplantation were very similar for infants initiated on PD or HD therapy.
Introduction and Aims: Asymptomatic elevated uric acid levels are frequent in CKD. Lowering uric acid with allopurinol improves GFR, BP and might decrease cardiovascular events in CKD patients. The aim of the study was to investigate the influence of febuxostat on GFR and BP in non-diabetic patients with CKD 2-3 with mild hypertension and no history of gout. Methods: 56 patients with asymptomatic hyperuricemia and CKD 2-3 (GFR 54±3 ml/ min) were enrolled in 14-month randomized prospective open-label study in parallel
Renoprotection – a system of measures primarily pharmacological control, contributing to the continued preservation of renal function. Any medical activity or medicines that lead to a slowdown, suspension or reversion of eGFR could be considered as renoprotective. Currently, renoprotective drugs with evidence-based efficacy include angiotensin-converting enzyme inhibitors (ACEIs), and recently SGLT2 inhibitors. It is known that the therapeutic efficacy of renoprotective drugs depends on the initial eGFR. Hence, choosing renoprotection medicines, it is necessary to consider not only the estimated GFR (using the EPI formula), but also a functional renal reserve. Physiologically sound is the method of determining the renal reserve with oral administration of 0.45-0.50% sodium chloride solution at the rate of 0.5% of body weight. The definition of a renal reserve based on this technique, as a routine method for examining nephrological patients, provides additional information not only on the number of functioning nephrons, but also on their condition. Based on a retrospective analysis of more than 15 years of using ACEIs and studying the functional renal reserve, we proposed a differentiated approach to the appointment of renoprotective medicines in mono regime or drugs combination, taking into account the stage of the disease and the functional renal reserve for maximum preservation of functioning nephrons. This approach has been used by us for the past three years in clinical practice.
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