Progression of chronic kidney disease: Mechanisms and interventions in retardation

The incidence of chronic kidney disease (CKD) is increasing worldwide and is becoming a major concern for the healthcare. Approximately 1.8 million people, worldwide, are currently treated with renal replacement therapy (RRT), which consists primarily of kidney transplantation, hemodialysis, and peritoneal dialysis.1 and 2 More than 90% of these individuals live in industrialized nations, while availability of RRT is scarce in developing countries. It is estimated that more than 150 per million develop end-stage renal disease (ESRD) per year in India.3 and 4 The vast majority of these patients cannot afford renal replacement therapy on reaching ESRD and hence ESRD is equivalent to death in them.3 and 5 Primary prevention programs are very few compared to the burden of CKD,6 and 7 hence it is imperative to retard progression of CKD.Regardless of the underlying cause, CKD is characterized by relentless progression, which is postulated to result from a self-perpetuating vicious cycle of fibrosis activated after initial injury. This article discusses the mechanisms of progression, viz, hemodynamic factors, role of proteinuria, systemic hypertension and the role of various cytokines and growth factors with special emphasis on renin angiotension system and the evidence based interventions to retard it.