Hippokratia
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Peritoneal dialysis is the most important home dialysis treatment for end stage renal diseases and needs personal involvement, and support from the family. Peritoneal dialysis presented a number of discouraging technical problems and led to the belief that PD was not an appropriate renal replacement therapy, for patients with end stage renal disease. Despite the improvement of the method its rate remain low (11%) worldwide. ⋯ Late referral and the health care system seems to be very important factors that influence the dialysis modality choice. After the initiation of peritoneal dialysis we can see other factors that influence the survival of the method. The rate of peritonitis and the peritoneum function seems to be important issues.
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Chronic kidney disease (CKD) is a global health problem associated with considerable morbidity and mortality and despite advances in the treatment of end stage renal disease (ESRD) mechanisms to prevent and delay its progression are still being sought. The renin-angiotensin-aldosterone system (RAAS) plays a pivotal role in many of the pathophysiologic changes that lead to progression of renal disease. Traditionally RAAS was considered as an endocrine system and its principal role was to maintain blood pressure (BP). ⋯ Several studies support these agents reduce proteinuria and protect renal function, whereas the opposite is stated by others. According to guidelines, their use is recommended as first line agents in diabetic renal disease and non diabetic renal disease with albuminuria, whereas there is no data to support the same in non diabetic nonalbuminuric renal disease. Dual blockage of RAAS with the combination of ACEIs and ARBs could offer an alternative in strict RAAS blockade, but studies up to now can not prove its safety and the combination is not recommended until ongoing trials will provide new and unarguable results.