The prevailing medical wisdom is that chronic kidney disease is relentlessly progressive once it has begun. This journal article says: “Progression of chronic kidney disease (CKD) is inevitable. However, the last decade has witnessed tremendous achievements in this field.” The graph above shows my own kidney function progression over the last 4 years since I moved to Greenville. In 2018, my eGFR was 52. It had been below 60 a couple of times before. Normal is about 100. Dialysis begins at an eGFR of 15. I had lost half of my kidney function and was solidly in stage 3 chronic kidney disease. I am in my 70s and have a history of high blood pressure (160/100), prediabetes, high triglycerides, low good cholesterol, and extra abdominal weight (the metabolic syndrome). About 4 years ago, my irregular heartbeat (atrial fibrillation) became more frequent. I was having spells lasting about 5 minutes every three or 4 months. They became more frequent and longer. I was also found to have a 20% blockage near the end of one of my heart arteries. For these reasons, I increased my atorvastatin to 40 mg. daily, doubled my losartan, and doubled my eplerenone. I continued taking 500 mg. of metformin twice a day. I also doubled down on sugar and carb restriction and lost some weight.
These are the same medications and lifestyle recommendations used in a study that dramatically reduced progression to dialysis. Six times as many patients needed dialysis in usual care compared with optimal medical therapy (OMT). I treated 81 patien
ts with stage 3 chronic kidney disease with the OMT protocol and over an average follow-up of 2-3 years their eGFR improved by 7.5. OMT works because the interventions are antioxidant and anti-inflammatory (see the diagram below). The most common cause of chronic kidney disease is hypertension—especially when combined with diabetes. This is good evidence that it need not be relentlessly progressive, and we can do much better.
Chronic kidney disease is microvascular disease. Patients with chronic kidney disease (CKD) are likely to have microvascular disease of the heart as well. They have a cardiovascular mortality twenty times that of patients without that problem. In fact, patients with CKD are more likely to die of cardiovascular disease than progress to dialysis. Diabetic eye damage (retinopathy) and nerve damage (neuropathy) are microvascular diseases also. Optimal medical therapy for type 2 diabetes dramatically reduces the likelihood of these complications. For the first time, we can slow the progression of CKD.
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Wonderful!
My husband has kidney disease—mostly stable I will send this article to him.