TUESDAY, April 17 (HealthDay News) -- 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 kidney disease 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 randomized controlled trials for
screening or monitoring," said the study's lead author, Dr. Howard
Fink, a staff physician at the Veterans Affairs Medical Center in
But, when the reviewers looked at the treatment options
available to people with early-stage chronic kidney disease, 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
Results of the review are published in the April 17 issue of the
Annals of Internal Medicine.
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 chronic medical conditions, such as heart disease,
high blood pressure and diabetes. Most people don't have symptoms
of early chronic kidney disease. It is detected through urine and
Not everyone with chronic kidney disease will develop end-stage
renal disease and need dialysis, but having early chronic kidney
disease increases a person's risk of heart disease, stroke, kidney
failure 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
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
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
"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
ACE inhibitors and ARBs to be most effective for people with early
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.
Learn more about chronic kidney disease from the
National Kidney Foundation.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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