Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
-
There is growing awareness of a need not only to identify patients with chronic renal failure (CRF) at an earlier stage in the disease process, but also to initiate treatment strategies earlier, in order to delay both progression of CRF and co-morbid diseases and to define the optimal time required to prepare CRF patients for renal replacement therapy (RRT). These three strategies are linked, and rely on appropriate identification of patients at risk of renal disease. The challenge currently facing nephrologists is both how to minimize the consequences of late referral and how to improve the timeliness of referral. ⋯ There is ample evidence that strategies to delay progression of renal disease are effective, as are strategies to reduce cardiovascular disease. Anaemia and a fall in haemoglobin concentration have been associated with left ventricular hypertrophy and with growth of the left ventricle. A combined approach is necessary for best nephrological clinical practice, with a clear definition of early renal insufficiency; this will involve the development of tools to permit early identification of patients with early renal insufficiency, and the implementation of strategies to optimize treatments aimed at both delaying progression and preparing patients for RRT.