Slowing the Progression of Chronic Renal Parenchymal Disease

Abstract

End-stage renal failure (ESRF) is a major cause of morbidity and mortality in North America as well as in the rest of the world. In addition, the treatment of patients who have ESRF is quite expensive. It is estimated that for an in-hospital hemodialysis patient, the average annual cost is approximately $54,000 in Canadian dollars and a peritoneal dialysis patient's annual care costs approximately $32,000 in Canadian dollars, whereas a kidney transplant patient costs about $25,000 dollars a year in Canadian dollars. And as renal replacement therapy by hemodialysis, periltoneal dialysis or successful kidney transplantation prolongs survival in ESRF patients, new dialysis patients have been outnumbering those who die from ESRF. To complicate matters further, the number of ESRF patients have been on the rise the last two decades and is expected to continue to rise at a rate of about 6 to 10% per year through the next one to two decades, putting more strain on the national economy, human resources and on an already strained health care system. Therefore, it makes sense to slow down or delay the progression of chronic renal parenchymal disease, or when possible, to prevent it from happening altogether. In this article, we will review the mechanisms and course of progression of renal injury and elaborate on the currently recommended strategies to delay or halt the progression of chronic renal disease.