Medidas preventivas na doença renal crônica
Palavras-chave:
Doença renal crônica, Taxa de filtração glomerular, Proteinúria, PrevençãoResumo
A doença renal crônica é considerada problema de saúde pública em todo o mundo, o Brasil incluído. Independentemente da etiologia da doença de base, os principais desfechos em pacientes com DRC são as suas complicações (anemia, acidose metabólica, desnutrição e alteração do metabolismo de cálcio e fósforo), decorrentes da perda funcional renal, óbito (principalmente, por causas cardiovasculares) e perda de função renal. Estudos recentes indicam que estes desfechos indesejados podem ser prevenidos ou retardados se a DRC for diagnosticada precocemente e as medidas nefro e cardioprotetoras implementadas o mais rápido possível. O atual estagiamento da doença e uma descrição dessas medidas preventivas são apresentados neste artigo de atualização.
Referências
(National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(suppl 1):S1-S266;
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:1-150)
(Levey AS. Measurement of renal function in chronic renal disease. Kidney Int 1990; 38:167-84)
(Stevens LA, Coresh J, Greene T, Levey AS. Assessing kidney function – Measured and estimated glomerular filtration rate. New Engl J Med 2006; 354:2473-83)
(Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med 1999; 130:461-70)
(Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150:604-12)
(Zanocco JA, Nishida SK, Passos MT, Pereira AR, Silva MS, Pereira AB, Kirsztajn GM. Race adjustment for estimating glomerular filtration rate is not Always necessary. Nephron Extra. 2012 Jan;2(1):293-302)
(Magacho EJC, Pereira AC, Mansur HN, Bastos MG. Nomograma para a Estimação da Taxa de Filtração Glomerular baseado na Fórmula CKD-EPI. J Bras Nefrol 2012;34(3):313-315)
(James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311:507-520)
(Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guidelines for the treatment of hypertension in chronic kidney disease. http://www.kdigo.org/home/guidelines/ ckd-evaluation-management. Accessado em oito de julho, 2019)
(Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:1-150
(Sarafidis PA, Georgianos PI, Bakris GL. Advances in treatment of hyperkalemia in chronic kidney disease. Expert Opin Pharmacother. 2015;16:2205–2215)
(The Diabetes Control and Complications (DCCT) Research Group. Effect of intensive therapy on the development and progression of diabetic nephropathy in the Diabetes Control and Complications Trial. Kidney Int 1995; 47: 1703–1720;
Bilous R. Microvascular disease: what does the UKPDS tell us about diabetic nephropathy? Diabet Med 2008; 25(Suppl 2): 25–29;
Ismail-Beigi F, Craven T, Banerji MA et al. Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type 2 diabetes: an analysis of the ACCORD randomised trial. Lancet 376: 419–430;
Patel A, MacMahon S, Chalmers J et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008; 358: 2560–2572)
(The Diabetes Control and Complications (DCCT) Research Group. Effect of intensive therapy on the development and progression of diabetic nephropathy in the Diabetes Control and Complications Trial. Kidney Int 1995; 47: 1703–1720)
(DCCT/EDIC Research Group. Effect of intensive diabetes treatment onalbuminuria in type 1 diabetes: long-term follow-up of the Diabetes Control and Complications Trial and Epidemiology of Diabetes Interventions and Complications study. Lancet Diabetes Endocrinol. 2014;2:793-800)
(Wanner, C. et al. Empagliflozin and progression of kidney disease in type 2 diabetes. N. Engl. J. Med. 2016; 375, 323–334; Neal, B. et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N. Engl. J. Med. 2017; 377, 644–657;
Mann, J. F. E. et al. Liraglutide and renal outcomes in type 2 diabetes. N. Engl. J. Med.2017; 377, 839–848)
(Loniewski I, Wesson DE. Bicarbonate therapy for prevention of chronic kidney disease progression. Kidney Int. 2014;85:529-35;
Dobre M, Rahman M, Hostetter TH. Current status of bicarbonate in CKD. J Am Soc Nephrol. 2015;26:515-23;
Dobre M, Yang W, Chen J, et al. Association of serum bicarbonate with risk of renal and cardiovascular outcomes in CKD: a report from the chronic renal insufficiency cohort (CRIC) study. Am J Kidney Dis. 2013;62:670-8)
de Brito-Ashurst I, Varagunam M, Raftery MJ, Yaqoob MM. Bicarbonate supplementation slows progression of CKD and improves nutritional status. J Am Soc Nephrol. 2009;20:2075-84;
(Goraya N, Simoni J, Jo CH, Wesson DE. Treatment of metabolic acidosis in patients with stage 3 chronic kidney disease with fruits and vegetables or oral bicarbonate reduces urine angiotensinogen and preserves glomerular filtration rate. Kidney Int. 2014;86:1031-8)
Inker LA, Astor BC, Fox CH, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am J Kidney Dis. 2014;63:713-735)
(Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:1-150)
(Sarnak MJ, Tighiouart H, Manjunath G, et al. Anemia as a risk factor for cardiovascular disease in the Atherosclerosis Risk in Communities (ARIC) study. J Am Coll Cardiol 2002; 40:27–33)
(Thorp ML, Johnson ES, Yang X, Petrik AF, Platt R, Smith DH. Effect of anaemia on mortality, cardiovascular hospitalizations and end-stage renal disease among patients with chronic kidney disease. Nephrology (Carlton) 2009; 14:240–246)
(Parfrey PS. Critical appraisal of randomized controlled trials of anemia correction in patients with renal failure. Curr Opin Nephrol Hypertens 2011;20:177–181)
(Singh AK, Szczech L, Tang KL, et al; CHOIR Investigators. Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med 2006; 355:2085–2098
; Dru?eke TB, Locatelli F, Clyne N, et al; CREATE Investigators. Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med 2006; 355:2071–2084;
Pfeffer MA, Burdmann EA, Chen CY, et al; TREAT Investigators. A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease. N Engl J Med 2009; 361:2019–2032)
(Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:1-150)
(Silverberg DS, Iaina A, Peer G, et al. Intravenous iron supplementation for the treatment of the anemia of moderate to severe chronic renal failure patients not receiving dialysis. Am J Kidney Dis 1996; 27:234–238)
(Foley, R. N., Parfrey, P. S. & Sarnak, M. J. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am. J. Kidney Dis. 1988;32: S112–119)
(Szczech LA, Best PJ, Crowley E, et al. Outcomes of Patients With Chronic Renal Insufficiency in the Bypass Angioplasty Revascularization Investigation. Circulation 2002;105:2253-2258)
(Thadhani R, Pascual M, Bonventre JV. Acute renal failure. N Engl J Med. 996;334:1448-60; Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl. 2012; 2:1–138)
