Kidney disease, chronic initiation factors

Patients with diabetes and hypertension should initially be treated with either P-blockers, ACE inhibitors, ARBs, diuretics, or calcium channel blockers. There is a general consensus that therapy focused on RAAS inhibition by ACE inhibitors or ARBs may be optimal if the patient has additional cardiovascular risk factors such as left ventricular hypertrophy or chronic kidney disease.2,3,59,67... 

Kalayjian RC, Lau B, Mechekano RN, Crane HM, Rodriguez B, Salata RA, et al. Risk factors for chronic kidney disease in a large cohort of HIV-1 infected individuals initiating antiretroviral therapy in routine care. AIDS 2012 26(15) 1907-15. 

Anemia is also an independent risk factor for progression of chronic renal failure. The anemia of CKD is, in most patients, normocytic and normochromic, and is due primarily to reduced production of erythropoietin (EPO) by the kidney (a presumed reflection of the reduction in functioning renal mass), low iron stores and shortened red cell survival. In 40%, it could be corrected by iron replacement. Early initiation of EPO therapy in patients with CKD and mild to moderate anemia significantly slowed down the progression of renal disease and delayed the need for renal replacement therapy. The target level of hemoglobin is llOg/1 [10],... 

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