Saturday, August 27, 2011

Chronic Kidney Disease:Things to Know. Part 2

In a recent post, I discussed things to know about chronic kidney disease for people with diabetes.

Among the things to know is that too often doctors, including nephrologists, don't prescribe drugs that are proven helpful for the kidneys.

There are several reasons for this inadequate care for people with chronic kidney disease due to diabetes.
A recent study deals with one possible reason. Results of this study are similar to a previous analysis.

Angiotensin converting enzyme inhibitors, abbreviated ACE inhibitors, and angiotensin receptor blockers, abbreviated ARBs, are the drugs with the best evidence for kidney benefit.

When an ACE inhibitor or ARB is started on a person with reduced kidney function, an increase in blood level of creatinine may occur. Blood creatinine, more accurately serum creatinine, is a measure of kidney function. In general, the higher the serum creatinine, the worse the kidney function.

So an increase in creatinine scares the doctor. She might just go ahead and stop the drug. She might be worried that the ACE inhibitor or ARB is making the kidney function worse because the creatinine went up.

It turns out that an increased serum creatinine is common within the first 2 months after an ACE inhibitor or ARB is started . And those people who have the increases in creatinine at the start of therapy actually have the best results over time from the drug. That means they have the most benefit at slowing the rate of loss of kidney function. Their kidney function is more likely to be stable over time as compared to people whose serum creatinine does not change soon after starting the ACE inhibitor or ARB.

An increase of  up to 30% in serum creatinine is okay. The increase in creatinine over the first two months or so actually means the drug is working.

So if you have chronic kidney disease, abbreviated CKD, from diabetes, ask if you are on an ACE inhibitor or ARB. If not, find out why not. If you are not satisfied with the answer you get, consider getting another opinion from another nephrologist.

After all, what can we offer people with CKD to prevent their kidney function from getting worse? Here are four things to know: ACE inhibitor or ARB therapy, good blood pressure control,  good blood sugar control and don't take things that might harm your kidneys. That’s all we have for now.

There is hope for additional therapy. An agent in development called bardoxolone shows promise.

In the meantime, be sure you do all you can and keep in mind these things to know about chronic kidney disease.

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