Strategies to Prevent and Delay Chronic Kidney Disease Progression: A Pathway to Sustainability and Green Nephrology

Abstract

Chronic kidney disease prevalence is increasing worldwide and is responsible for important morbidity, mortality and poor quality of life. Progression to end stage renal disease leads to major sustainability burden with high consumption of human and material resources. Hemodialysis particularly is associated with high rates of water consumption, waste production and greenhouse gas emissions. The nephrology community is gaining environmental awareness and several international societies are creating specific groups focusing on green nephrology. The first concerns are centered in the impact of hemodialysis, but it is unanimous that chronic kidney disease prevention and delayed progression are the most important measures to sustainability. New drug classes such as SGLT-2 inhibitors, selective mineralocorticoid receptors antagonists and GLP-1 analogues are revolutionizing the treatment of proteinuric and non-proteinuric chronic kidney disease. Large randomized clinical trials have proved strong and sustained benefits in renal and cardiovascular outcomes, and these drugs are now first and second-line therapy for the treatment of diabetic and non-diabetic kidney disease. In this mini-review article we explore the prevalence of chronic kidney disease, its environmental impact and resume the major strategies to prevent and delay its progression, including recent evidence on pharmacotherapy. Implementing prevention strategies and adopting environmentally-friendly practices, is the key to a better patient care and a greener nephrology.