the
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citizen
kidney disease (PKD), there has been a relative lack of data
suggesting any one medication that has proven to be beneficial in slowing progression to dialysis dependent kidney failure.
Again, ACE inhibitors have been shown to be effective in controlling blood pressure in PKD patients, but without as great an
effect on kidney preservation as in other patient groups. There
is great hope that newer compounds will soon be available to
slow the loss of kidney function in PKD. Trials are currently
underway looking at the vasopressin
receptor antagonist tolvaptan and
its effects in PKD patients. This is a
medication already being used to
treat PKD in other parts of the world.
Many in the nephrology community
(including myself) are optimistic that
tolvaptan will receive FDA approval for use in PKD patients within the
next few years.
11
Finally, we have seen studies in recent years suggesting the
possibility of severe kidney damage from the use of oral sodium
phosphate based preparations used for colonoscopies or as
laxatives. Patients with CKD should not be given these agents.
The good news is that there are now many other safer options
that can be given prior to colonoscopy. Be sure to discuss any
diagnosis of CKD with your gastroenterologist before taking a
colon cleansing preparation.
Finally, it is worth mentioning some
other non-traditional approaches to
preventing CKD progression. Data
have shown that vitamin D has been
able to reduce proteinuria in patients
with CKD. Sodium bicarbonate has
also been shown to preserve kidney
function in CKD patients with low bicarbonate levels compared to placebo.
In addition to all the beneficial things
we can tell a patient to take in an effort to preserve their
kidney function, I should also point out some of the things
to avoid which may worsen existing kidney disease. The pain
medications known as non-steroidal anti-inflammatory drugs
(NSAIDs) and COX-2 inhibitors can cause transient worsening in
kidney function. While they are helpful in reducing pain, they
are not re-commended for chronic use in CKD patients. One
tablet on its own may not have any las